- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,000.00 / $3,684.00 / $8,400.00
| Facility | | $1,000.00 | $3,684.00 | $8,400.00 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $3,966.27 / $6,203.47 / $9,729.79
| Facility | | $3,966.27 | $6,203.47 | $9,729.79 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,141.83 / $1,141.83 / $1,141.83
| Facility | | $1,141.83 | $1,141.83 | $1,141.83 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $366.50 / $503.51 / $4,083.73
| Facility | | $366.50 | $503.51 | $4,083.73 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $575.00 / $1,990.00 / $4,012.00
| Facility | | $575.00 | $1,990.00 | $4,012.00 |