- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2,994.50 / $10,036.90 / $13,884.90
| Facility | | $2,994.50 | $10,036.90 | $13,884.90 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,146.00 / $3,000.00 / $10,762.68
| Facility | | $1,146.00 | $3,000.00 | $10,762.68 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $3,777.76 / $5,219.71 / $9,681.82
| Facility | | $3,777.76 | $5,219.71 | $9,681.82 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $3,777.76 / $5,219.71 / $9,681.82
| Facility | | $3,777.76 | $5,219.71 | $9,681.82 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $3,036.00 / $6,770.56 / $13,438.00
| Facility | | $3,036.00 | $6,770.56 | $13,438.00 |