- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,760.00 / $4,470.00 / $12,154.00
| Facility | | $1,760.00 | $4,470.00 | $12,154.00 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2,234.00 / $4,286.00 / $10,043.00
| Facility | | $2,234.00 | $4,286.00 | $10,043.00 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2,530.00 / $2,530.00 / $2,530.00
| Facility | | $2,530.00 | $2,530.00 | $2,530.00 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,392.80 / $2,255.38 / $4,048.46
| Facility | | $1,392.80 | $2,255.38 | $4,048.46 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,189.00 / $3,300.00 / $11,186.00
| Facility | | $1,189.00 | $3,300.00 | $11,186.00 |