- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $889.57 / $8,960.00 / $18,276.00
| Facility | | $889.57 | $8,960.00 | $18,276.00 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2,950.25 / $6,390.72 / $11,041.04
| Facility | | $2,950.25 | $6,390.72 | $11,041.04 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $715.00 / $910.25 / $2,581.96
| Facility | | $715.00 | $910.25 | $2,581.96 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $913.70 / $1,284.65 / $1,883.00
| Facility | | $913.70 | $1,284.65 | $1,883.00 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2,155.00 / $12,456.00 / $19,591.00
| Facility | | $2,155.00 | $12,456.00 | $19,591.00 |