- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $3,160.00 / $10,591.60 / $14,652.30
| Facility | | $3,160.00 | $10,591.60 | $14,652.30 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,146.00 / $2,581.25 / $4,004.38
| Facility | | $1,146.00 | $2,581.25 | $4,004.38 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $3,986.55 / $5,508.20 / $10,216.91
| Facility | | $3,986.55 | $5,508.20 | $10,216.91 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $3,986.55 / $5,688.00 / $10,216.91
| Facility | | $3,986.55 | $5,688.00 | $10,216.91 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $3,036.00 / $7,049.96 / $10,931.07
| Facility | | $3,036.00 | $7,049.96 | $10,931.07 |