- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $3,138.50 / $10,519.60 / $14,552.60
| Facility | | $3,138.50 | $10,519.60 | $14,552.60 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,146.00 / $1,775.55 / $3,000.00
| Facility | | $1,146.00 | $1,775.55 | $3,000.00 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $3,959.42 / $5,470.72 / $10,147.40
| Facility | | $3,959.42 | $5,470.72 | $10,147.40 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $3,959.42 / $5,470.72 / $10,147.40
| Facility | | $3,959.42 | $5,470.72 | $10,147.40 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $3,036.00 / $7,001.99 / $10,856.70
| Facility | | $3,036.00 | $7,001.99 | $10,856.70 |