- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,110.00 / $3,214.00 / $7,365.00
| Facility | | $1,110.00 | $3,214.00 | $7,365.00 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $862.00 / $1,785.00 / $4,773.00
| Facility | | $862.00 | $1,785.00 | $4,773.00 |
- 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
- $790.13 / $1,298.45 / $4,553.00
| Facility | | $790.13 | $1,298.45 | $4,553.00 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2,155.00 / $3,233.00 / $5,740.00
| Facility | | $2,155.00 | $3,233.00 | $5,740.00 |