- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $3,600.00 / $12,066.40 / $16,692.50
| Facility | | $3,600.00 | $12,066.40 | $16,692.50 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,146.00 / $2,740.85 / $4,216.41
| Facility | | $1,146.00 | $2,740.85 | $4,216.41 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $4,541.64 / $6,275.16 / $11,639.52
| Facility | | $4,541.64 | $6,275.16 | $11,639.52 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $4,541.64 / $6,275.16 / $11,639.52
| Facility | | $4,541.64 | $6,275.16 | $11,639.52 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $3,384.00 / $8,031.60 / $12,453.12
| Facility | | $3,384.00 | $8,031.60 | $12,453.12 |