- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,098.00 / $3,362.00 / $7,365.00
| Facility | | $1,098.00 | $3,362.00 | $7,365.00 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2,088.00 / $4,247.00 / $9,663.00
| Facility | | $2,088.00 | $4,247.00 | $9,663.00 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $517.00 / $517.00 / $1,135.71
| Facility | | $517.00 | $517.00 | $1,135.71 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $149.16 / $1,790.00 / $16,394.00
| Facility | | $149.16 | $1,790.00 | $16,394.00 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,438.00 / $2,833.00 / $5,813.00
| Facility | | $1,438.00 | $2,833.00 | $5,813.00 |