- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,000.00 / $3,612.00 / $8,400.00
| Facility | | $1,000.00 | $3,612.00 | $8,400.00 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $4,653.03 / $7,392.01 / $11,679.29
| Facility | | $4,653.03 | $7,392.01 | $11,679.29 |
- 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
- $405.92 / $597.36 / $4,596.00
| Facility | | $405.92 | $597.36 | $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 |