- 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
- $3,794.37 / $6,027.89 / $9,524.00
| Facility | | $3,794.37 | $6,027.89 | $9,524.00 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $18,345.30 / $18,345.30 / $18,345.30
| Facility | | $18,345.30 | $18,345.30 | $18,345.30 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $686.74 / $1,100.74 / $11,615.00
| Facility | | $686.74 | $1,100.74 | $11,615.00 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,851.00 / $7,307.00 / $14,139.00
| Facility | | $1,851.00 | $7,307.00 | $14,139.00 |