- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $849.70 / $9,062.00 / $18,276.00
| Facility | | $849.70 | $9,062.00 | $18,276.00 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $3,366.50 / $7,206.40 / $12,212.57
| Facility | | $3,366.50 | $7,206.40 | $12,212.57 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $715.00 / $845.53 / $13,746.36
| Facility | | $715.00 | $845.53 | $13,746.36 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $819.70 / $1,019.64 / $1,627.32
| Facility | | $819.70 | $1,019.64 | $1,627.32 |
- 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 |