- 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
- $3,557.84 / $5,628.59 / $8,810.78
| Facility | | $3,557.84 | $5,628.59 | $8,810.78 |
- 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
- $651.16 / $905.63 / $4,393.26
| Facility | | $651.16 | $905.63 | $4,393.26 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $498.00 / $1,928.00 / $4,012.00
| Facility | | $498.00 | $1,928.00 | $4,012.00 |