- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $3,360.00 / $11,262.00 / $15,579.60
| Facility | | $3,360.00 | $11,262.00 | $15,579.60 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,146.00 / $3,000.00 / $4,725.59
| Facility | | $1,146.00 | $3,000.00 | $4,725.59 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $4,238.85 / $5,856.82 / $10,863.55
| Facility | | $4,238.85 | $5,856.82 | $10,863.55 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $4,238.85 / $5,856.82 / $10,863.55
| Facility | | $4,238.85 | $5,856.82 | $10,863.55 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $3,158.40 / $7,496.16 / $11,622.91
| Facility | | $3,158.40 | $7,496.16 | $11,622.91 |