- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,110.00 / $3,214.00 / $7,365.00
| Facility | | $1,110.00 | $3,214.00 | $7,365.00 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $862.00 / $1,785.00 / $4,773.00
| Facility | | $862.00 | $1,785.00 | $4,773.00 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2,213.00 / $2,213.00 / $2,213.00
| Facility | | $2,213.00 | $2,213.00 | $2,213.00 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $737.66 / $1,209.51 / $5,504.00
| Facility | | $737.66 | $1,209.51 | $5,504.00 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2,285.00 / $4,000.00 / $9,817.00
| Facility | | $2,285.00 | $4,000.00 | $9,817.00 |