- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,332.04 / $3,396.00 / $14,063.00
| Facility | | $1,332.04 | $3,396.00 | $14,063.00 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2,807.00 / $6,653.00 / $11,752.00
| Facility | | $2,807.00 | $6,653.00 | $11,752.00 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,282.67 / $1,868.32 / $2,012.04
| Facility | | $1,282.67 | $1,868.32 | $2,012.04 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,314.83 / $1,314.83 / $1,314.83
| Facility | | $1,314.83 | $1,314.83 | $1,314.83 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $3,364.00 / $6,094.00 / $10,413.00
| Facility | | $3,364.00 | $6,094.00 | $10,413.00 |