- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,098.00 / $3,214.00 / $7,365.00
| Facility | | $1,098.00 | $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 / $2,769.00 / $4,641.00
| Facility | | $2,213.00 | $2,769.00 | $4,641.00 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $280.52 / $475.29 / $2,672.00
| Facility | | $280.52 | $475.29 | $2,672.00 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,380.00 / $2,332.00 / $3,041.00
| Facility | | $1,380.00 | $2,332.00 | $3,041.00 |