- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $564.96 / $9,062.00 / $18,276.00
| Facility | | $564.96 | $9,062.00 | $18,276.00 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2,251.80 / $5,908.67 / $10,140.68
| Facility | | $2,251.80 | $5,908.67 | $10,140.68 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $3,208.42 / $3,208.42 / $4,122.88
| Facility | | $3,208.42 | $3,208.42 | $4,122.88 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $454.54 / $634.65 / $1,031.76
| Facility | | $454.54 | $634.65 | $1,031.76 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,981.00 / $10,069.00 / $16,249.00
| Facility | | $1,981.00 | $10,069.00 | $16,249.00 |