- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,125.15 / $3,214.00 / $7,365.00
| Facility | | $1,125.15 | $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
- $2,530.00 / $2,530.00 / $2,530.00
| Facility | | $2,530.00 | $2,530.00 | $2,530.00 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $844.54 / $1,272.83 / $3,318.00
| Facility | | $844.54 | $1,272.83 | $3,318.00 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2,063.86 / $3,233.00 / $5,740.00
| Facility | | $2,063.86 | $3,233.00 | $5,740.00 |