- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,000.00 / $3,602.00 / $10,635.00
| Facility | | $1,000.00 | $3,602.00 | $10,635.00 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,712.00 / $3,264.00 / $14,996.00
| Facility | | $1,712.00 | $3,264.00 | $14,996.00 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $898.50 / $1,308.33 / $1,308.33
| Facility | | $898.50 | $1,308.33 | $1,308.33 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $21,571.00 / $21,571.00 / $21,571.00
| Facility | | $21,571.00 | $21,571.00 | $21,571.00 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2,840.00 / $5,513.00 / $7,847.00
| Facility | | $2,840.00 | $5,513.00 | $7,847.00 |