- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,000.00 / $3,683.00 / $8,400.00
| Facility | | $1,000.00 | $3,683.00 | $8,400.00 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $4,064.77 / $6,457.50 / $10,202.77
| Facility | | $4,064.77 | $6,457.50 | $10,202.77 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2,545.78 / $2,545.78 / $2,545.78
| Facility | | $2,545.78 | $2,545.78 | $2,545.78 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $534.29 / $752.91 / $5,543.93
| Facility | | $534.29 | $752.91 | $5,543.93 |
- 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 |