- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $3,210.00 / $10,759.20 / $14,884.10
| Facility | | $3,210.00 | $10,759.20 | $14,884.10 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,146.00 / $3,000.00 / $5,550.04
| Facility | | $1,146.00 | $3,000.00 | $5,550.04 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $4,049.63 / $5,595.35 / $10,378.57
| Facility | | $4,049.63 | $5,595.35 | $10,378.57 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $4,049.63 / $5,778.00 / $10,378.57
| Facility | | $4,049.63 | $5,778.00 | $10,378.57 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $3,036.00 / $7,161.51 / $11,104.03
| Facility | | $3,036.00 | $7,161.51 | $11,104.03 |