- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $3,331.50 / $11,166.50 / $15,447.50
| Facility | | $3,331.50 | $11,166.50 | $15,447.50 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,146.00 / $2,226.69 / $3,533.33
| Facility | | $1,146.00 | $2,226.69 | $3,533.33 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $4,202.91 / $5,807.14 / $10,771.41
| Facility | | $4,202.91 | $5,807.14 | $10,771.41 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $4,202.91 / $5,807.14 / $10,771.41
| Facility | | $4,202.91 | $5,807.14 | $10,771.41 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $3,131.61 / $7,432.58 / $11,524.32
| Facility | | $3,131.61 | $7,432.58 | $11,524.32 |