- 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
- $862.00 / $1,785.00 / $4,773.00
| Facility | | $862.00 | $1,785.00 | $4,773.00 |
- 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
- $406.26 / $656.50 / $3,532.00
| Facility | | $406.26 | $656.50 | $3,532.00 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,438.00 / $2,833.00 / $5,200.00
| Facility | | $1,438.00 | $2,833.00 | $5,200.00 |