- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,072.00 / $3,034.00 / $5,691.00
| Facility | | $1,072.00 | $3,034.00 | $5,691.00 |
- 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
- $451.15 / $734.52 / $2,745.00
| Facility | | $451.15 | $734.52 | $2,745.00 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,216.00 / $2,332.00 / $3,041.00
| Facility | | $1,216.00 | $2,332.00 | $3,041.00 |