- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $853.26 / $9,062.00 / $18,276.00
| Facility | | $853.26 | $9,062.00 | $18,276.00 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2,587.92 / $6,454.34 / $11,190.33
| Facility | | $2,587.92 | $6,454.34 | $11,190.33 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $715.00 / $841.83 / $2,581.96
| Facility | | $715.00 | $841.83 | $2,581.96 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $777.51 / $1,023.91 / $1,519.05
| Facility | | $777.51 | $1,023.91 | $1,519.05 |
- 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 |