- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,930.00 / $7,655.00 / $14,450.00
| Facility | | $1,930.00 | $7,655.00 | $14,450.00 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $3,166.00 / $4,076.92 / $6,787.73
| Facility | | $3,166.00 | $4,076.92 | $6,787.73 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $914.00 / $914.00 / $914.00
| Facility | | $914.00 | $914.00 | $914.00 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $967.67 / $1,344.35 / $2,288.58
| Facility | | $967.67 | $1,344.35 | $2,288.58 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $783.00 / $1,743.00 / $5,562.00
| Facility | | $783.00 | $1,743.00 | $5,562.00 |