- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,110.00 / $3,907.00 / $12,154.00
| Facility | | $1,110.00 | $3,907.00 | $12,154.00 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2,088.00 / $4,286.00 / $10,043.00
| Facility | | $2,088.00 | $4,286.00 | $10,043.00 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,083.00 / $10,223.00 / $15,638.00
| Facility | | $1,083.00 | $10,223.00 | $15,638.00 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $638.47 / $1,099.83 / $19,577.79
| Facility | | $638.47 | $1,099.83 | $19,577.79 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2,695.00 / $5,285.00 / $19,082.00
| Facility | | $2,695.00 | $5,285.00 | $19,082.00 |