- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $619.20 / $8,477.27 / $20,928.72
| Facility | | $619.20 | $8,477.27 | $20,928.72 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $7,921.80 / $10,419.34 / $20,154.36
| Facility | | $7,921.80 | $10,419.34 | $20,154.36 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $619.20 / $1,145.52 / $4,806.00
| Facility | | $619.20 | $1,145.52 | $4,806.00 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $828.20 / $1,539.97 / $2,171.17
| Facility | | $828.20 | $1,539.97 | $2,171.17 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $6,777.00 / $8,220.00 / $9,696.00
| Facility | | $6,777.00 | $8,220.00 | $9,696.00 |