- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,000.00 / $3,779.00 / $12,600.00
| Facility | | $1,000.00 | $3,779.00 | $12,600.00 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,204.72 / $1,913.86 / $3,023.88
| Facility | | $1,204.72 | $1,913.86 | $3,023.88 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,937.60 / $1,937.60 / $1,937.60
| Facility | | $1,937.60 | $1,937.60 | $1,937.60 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $228.82 / $461.75 / $4,596.00
| Facility | | $228.82 | $461.75 | $4,596.00 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $884.00 / $2,900.00 / $5,543.93
| Facility | | $884.00 | $2,900.00 | $5,543.93 |