- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,000.00 / $3,742.00 / $18,600.00
| Facility | | $1,000.00 | $3,742.00 | $18,600.00 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $3,878.46 / $6,161.50 / $9,735.10
| Facility | | $3,878.46 | $6,161.50 | $9,735.10 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $900.00 / $900.00 / $900.00
| Facility | | $900.00 | $900.00 | $900.00 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $469.17 / $774.75 / $2,490.86
| Facility | | $469.17 | $774.75 | $2,490.86 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $347.00 / $806.02 / $1,582.00
| Facility | | $347.00 | $806.02 | $1,582.00 |