- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,167.53 / $1,390.05 / $13,304.00
| Facility | | $1,167.53 | $1,390.05 | $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
- $1,299.45 / $1,769.15 / $2,040.85
| Facility | | $1,299.45 | $1,769.15 | $2,040.85 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,290.96 / $1,580.01 / $1,580.01
| Facility | | $1,290.96 | $1,580.01 | $1,580.01 |
- 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 |