- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $3,770.00 / $12,636.20 / $17,480.70
| Facility | | $3,770.00 | $12,636.20 | $17,480.70 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,146.00 / $1,685.25 / $3,000.00
| Facility | | $1,146.00 | $1,685.25 | $3,000.00 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $4,756.10 / $6,571.49 / $12,189.16
| Facility | | $4,756.10 | $6,571.49 | $12,189.16 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $4,756.10 / $6,786.00 / $12,189.16
| Facility | | $4,756.10 | $6,786.00 | $12,189.16 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $3,543.80 / $7,050.00 / $13,041.18
| Facility | | $3,543.80 | $7,050.00 | $13,041.18 |