- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,098.00 / $3,213.00 / $7,365.00
| Facility | | $1,098.00 | $3,213.00 | $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
- $6,644.00 / $6,644.00 / $6,644.00
| Facility | | $6,644.00 | $6,644.00 | $6,644.00 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $247.49 / $1,077.23 / $2,617.78
| Facility | | $247.49 | $1,077.23 | $2,617.78 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,708.00 / $3,527.00 / $6,854.00
| Facility | | $1,708.00 | $3,527.00 | $6,854.00 |