- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $3,170.00 / $10,625.20 / $14,698.70
| Facility | | $3,170.00 | $10,625.20 | $14,698.70 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,146.00 / $3,000.00 / $9,993.11
| Facility | | $1,146.00 | $3,000.00 | $9,993.11 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $3,999.16 / $5,525.63 / $10,249.24
| Facility | | $3,999.16 | $5,525.63 | $10,249.24 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $3,999.16 / $5,706.00 / $10,249.24
| Facility | | $3,999.16 | $5,706.00 | $10,249.24 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $3,036.00 / $7,072.27 / $10,965.66
| Facility | | $3,036.00 | $7,072.27 | $10,965.66 |