- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,194.00 / $1,463.64 / $13,304.00
| Facility | | $1,194.00 | $1,463.64 | $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
- $1,367.95 / $1,862.81 / $2,148.88
| Facility | | $1,367.95 | $1,862.81 | $2,148.88 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,370.43 / $1,657.19 / $1,657.19
| Facility | | $1,370.43 | $1,657.19 | $1,657.19 |
- 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 |