- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,125.00 / $4,498.00 / $12,237.00
| Facility | | $1,125.00 | $4,498.00 | $12,237.00 |
- 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
- $693.75 / $2,209.00 / $7,049.14
| Facility | | $693.75 | $2,209.00 | $7,049.14 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2,426.00 / $4,432.00 / $18,451.37
| Facility | | $2,426.00 | $4,432.00 | $18,451.37 |