- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $3,025.00 / $10,139.10 / $14,026.30
| Facility | | $3,025.00 | $10,139.10 | $14,026.30 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,146.00 / $2,572.50 / $3,992.75
| Facility | | $1,146.00 | $2,572.50 | $3,992.75 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $3,816.24 / $5,272.88 / $9,780.43
| Facility | | $3,816.24 | $5,272.88 | $9,780.43 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $3,816.24 / $5,445.00 / $9,780.43
| Facility | | $3,816.24 | $5,445.00 | $9,780.43 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $3,036.00 / $6,748.78 / $10,464.08
| Facility | | $3,036.00 | $6,748.78 | $10,464.08 |