- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $275.64 / $7,119.04 / $20,928.72
| Facility | | $275.64 | $7,119.04 | $20,928.72 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $7,828.40 / $10,296.48 / $19,916.72
| Facility | | $7,828.40 | $10,296.48 | $19,916.72 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $275.64 / $482.37 / $1,510.80
| Facility | | $275.64 | $482.37 | $1,510.80 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $367.25 / $726.35 / $1,009.47
| Facility | | $367.25 | $726.35 | $1,009.47 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $3,054.00 / $4,317.00 / $13,909.00
| Facility | | $3,054.00 | $4,317.00 | $13,909.00 |