- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $738.60 / $9,062.00 / $18,276.00
| Facility | | $738.60 | $9,062.00 | $18,276.00 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2,692.18 / $5,736.30 / $9,670.36
| Facility | | $2,692.18 | $5,736.30 | $9,670.36 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $715.00 / $715.00 / $1,985.43
| Facility | | $715.00 | $715.00 | $1,985.43 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $503.00 / $685.66 / $1,040.76
| Facility | | $503.00 | $685.66 | $1,040.76 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,258.00 / $10,257.00 / $16,249.00
| Facility | | $1,258.00 | $10,257.00 | $16,249.00 |