- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,243.00 / $2,275.03 / $13,304.00
| Facility | | $1,243.00 | $2,275.03 | $13,304.00 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $3,104.00 / $5,280.00 / $12,101.00
| Facility | | $3,104.00 | $5,280.00 | $12,101.00 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,721.51 / $2,362.85 / $2,725.72
| Facility | | $1,721.51 | $2,362.85 | $2,725.72 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2,086.03 / $2,086.03 / $2,086.03
| Facility | | $2,086.03 | $2,086.03 | $2,086.03 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $719.00 / $1,298.00 / $10,113.00
| Facility | | $719.00 | $1,298.00 | $10,113.00 |