- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $880.10 / $1,047.22 / $10,152.00
| Facility | | $880.10 | $1,047.22 | $10,152.00 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2,320.00 / $4,334.00 / $11,433.00
| Facility | | $2,320.00 | $4,334.00 | $11,433.00 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $979.35 / $1,332.83 / $1,537.52
| Facility | | $979.35 | $1,332.83 | $1,537.52 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $950.49 / $1,193.77 / $1,193.77
| Facility | | $950.49 | $1,193.77 | $1,193.77 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $842.00 / $4,539.00 / $10,113.00
| Facility | | $842.00 | $4,539.00 | $10,113.00 |