- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,194.00 / $1,669.60 / $13,304.00
| Facility | | $1,194.00 | $1,669.60 | $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
- $1,559.53 / $2,124.94 / $2,451.29
| Facility | | $1,559.53 | $2,124.94 | $2,451.29 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,559.77 / $1,879.27 / $1,879.27
| Facility | | $1,559.77 | $1,879.27 | $1,879.27 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $842.00 / $4,539.00 / $10,113.00
| Facility | | $842.00 | $4,539.00 | $10,113.00 |