- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $3,350.00 / $11,228.50 / $15,533.30
| Facility | | $3,350.00 | $11,228.50 | $15,533.30 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,146.00 / $3,000.00 / $4,621.43
| Facility | | $1,146.00 | $3,000.00 | $4,621.43 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $4,226.25 / $5,839.39 / $10,831.22
| Facility | | $4,226.25 | $5,839.39 | $10,831.22 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $4,226.25 / $5,839.39 / $10,831.22
| Facility | | $4,226.25 | $5,839.39 | $10,831.22 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $3,149.00 / $7,473.85 / $11,588.32
| Facility | | $3,149.00 | $7,473.85 | $11,588.32 |