- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,110.00 / $4,261.00 / $12,154.00
| Facility | | $1,110.00 | $4,261.00 | $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
- $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
- $149.68 / $234.47 / $533.54
| Facility | | $149.68 | $234.47 | $533.54 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $247.00 / $747.00 / $1,300.00
| Facility | | $247.00 | $747.00 | $1,300.00 |