- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,000.00 / $3,715.35 / $12,882.50
| Facility | | $1,000.00 | $3,715.35 | $12,882.50 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2,041.74 / $2,041.74 / $2,137.96
| Facility | | $2,041.74 | $2,041.74 | $2,137.96 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $891.25 / $2,511.89 / $3,981.07
| Facility | | $891.25 | $2,511.89 | $3,981.07 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $54.95 / $56.23 / $21,379.62
| Facility | | $54.95 | $56.23 | $21,379.62 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,995.26 / $2,818.38 / $5,248.07
| Facility | | $1,995.26 | $2,818.38 | $5,248.07 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2,041.74 / $2,818.38 / $5,011.87
| Facility | | $2,041.74 | $2,818.38 | $5,011.87 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $407.38 / $2,290.87 / $10,000.00
| Facility | | $407.38 | $2,290.87 | $10,000.00 |