- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $4,171.95 / $8,656.28 / $11,611.60
| Facility | | $4,171.95 | $8,656.28 | $11,611.60 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $4,290.00 / $4,975.50 / $17,622.50
| Facility | | $4,290.00 | $4,975.50 | $17,622.50 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $850.00 / $850.00 / $850.00
| Facility | | $850.00 | $850.00 | $850.00 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $7,357.84 / $10,854.22 / $12,184.66
| Facility | | $7,357.84 | $10,854.22 | $12,184.66 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,350.00 / $5,713.00 / $11,043.34
| Facility | | $1,350.00 | $5,713.00 | $11,043.34 |