- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2,643.44 / $7,655.00 / $14,670.00
| Facility | | $2,643.44 | $7,655.00 | $14,670.00 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $3,166.00 / $4,280.76 / $6,787.73
| Facility | | $3,166.00 | $4,280.76 | $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
- $1,789.00 / $2,537.92 / $4,857.00
| Facility | | $1,789.00 | $2,537.92 | $4,857.00 |
- 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 |