- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $851.00 / $2,782.00 / $7,365.00
| Facility | | $851.00 | $2,782.00 | $7,365.00 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2,180.00 / $4,050.00 / $9,663.00
| Facility | | $2,180.00 | $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
- $107.86 / $166.74 / $1,380.00
| Facility | | $107.86 | $166.74 | $1,380.00 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,216.00 / $2,332.00 / $3,041.00
| Facility | | $1,216.00 | $2,332.00 | $3,041.00 |