- 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
- $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
- $2,213.00 / $2,213.00 / $2,213.00
| Facility | | $2,213.00 | $2,213.00 | $2,213.00 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $531.96 / $854.71 / $2,783.00
| Facility | | $531.96 | $854.71 | $2,783.00 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,380.00 / $2,169.08 / $2,745.00
| Facility | | $1,380.00 | $2,169.08 | $2,745.00 |