- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $783.33 / $1,010.27 / $10,152.00
| Facility | | $783.33 | $1,010.27 | $10,152.00 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $7,212.00 / $9,015.00 / $11,253.00
| Facility | | $7,212.00 | $9,015.00 | $11,253.00 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $847.22 / $1,158.44 / $1,336.35
| Facility | | $847.22 | $1,158.44 | $1,336.35 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $938.34 / $1,022.94 / $1,022.94
| Facility | | $938.34 | $1,022.94 | $1,022.94 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $739.00 / $3,828.00 / $8,582.00
| Facility | | $739.00 | $3,828.00 | $8,582.00 |