- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,224.44 / $4,470.00 / $12,154.00
| Facility | | $1,224.44 | $4,470.00 | $12,154.00 |
- 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
- $3,125.00 / $3,125.00 / $3,125.00
| Facility | | $3,125.00 | $3,125.00 | $3,125.00 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $516.79 / $842.88 / $4,553.00
| Facility | | $516.79 | $842.88 | $4,553.00 |
- 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 |