- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,110.00 / $4,261.00 / $12,154.00
| Facility | | $1,110.00 | $4,261.00 | $12,154.00 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2,114.00 / $4,050.00 / $9,663.00
| Facility | | $2,114.00 | $4,050.00 | $9,663.00 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2,530.00 / $2,530.00 / $2,530.00
| Facility | | $2,530.00 | $2,530.00 | $2,530.00 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $869.71 / $1,337.85 / $2,964.52
| Facility | | $869.71 | $1,337.85 | $2,964.52 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,694.00 / $2,959.00 / $5,620.00
| Facility | | $1,694.00 | $2,959.00 | $5,620.00 |