- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,098.00 / $3,213.00 / $7,365.00
| Facility | | $1,098.00 | $3,213.00 | $7,365.00 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $770.00 / $1,508.00 / $3,523.00
| Facility | | $770.00 | $1,508.00 | $3,523.00 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2,437.00 / $4,084.00 / $4,641.00
| Facility | | $2,437.00 | $4,084.00 | $4,641.00 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $172.96 / $283.72 / $3,318.00
| Facility | | $172.96 | $283.72 | $3,318.00 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,433.00 / $3,347.00 / $6,653.00
| Facility | | $1,433.00 | $3,347.00 | $6,653.00 |