- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $886.67 / $9,062.00 / $18,276.00
| Facility | | $886.67 | $9,062.00 | $18,276.00 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $3,154.44 / $6,537.29 / $11,190.33
| Facility | | $3,154.44 | $6,537.29 | $11,190.33 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $715.00 / $879.48 / $5,740.31
| Facility | | $715.00 | $879.48 | $5,740.31 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $806.86 / $1,055.14 / $1,562.51
| Facility | | $806.86 | $1,055.14 | $1,562.51 |
- 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 |