- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,000.00 / $2,691.53 / $6,456.54
| Facility | | $1,000.00 | $2,691.53 | $6,456.54 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2,290.87 / $4,168.69 / $5,888.44
| Facility | | $2,290.87 | $4,168.69 | $5,888.44 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2,187.76 / $2,187.76 / $2,187.76
| Facility | | $2,187.76 | $2,187.76 | $2,187.76 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $9,549.93 / $9,549.93 / $42,657.95
| Facility | | $9,549.93 | $9,549.93 | $42,657.95 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2,041.74 / $3,630.78 / $6,309.57
| Facility | | $2,041.74 | $3,630.78 | $6,309.57 |