- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,391.00 / $4,069.00 / $10,746.00
| Facility | | $1,391.00 | $4,069.00 | $10,746.00 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2,651.00 / $5,486.00 / $9,272.00
| Facility | | $2,651.00 | $5,486.00 | $9,272.00 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $955.51 / $3,671.00 / $4,939.00
| Facility | | $955.51 | $3,671.00 | $4,939.00 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $4,676.39 / $16,547.20 / $26,542.00
| Facility | | $4,676.39 | $16,547.20 | $26,542.00 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,485.00 / $4,937.00 / $10,111.00
| Facility | | $1,485.00 | $4,937.00 | $10,111.00 |