- 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
- $557.11 / $908.63 / $4,553.00
| Facility | | $557.11 | $908.63 | $4,553.00 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,829.00 / $3,700.00 / $6,653.00
| Facility | | $1,829.00 | $3,700.00 | $6,653.00 |