- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,000.00 / $2,095.00 / $7,838.38
| Facility | | $1,000.00 | $2,095.00 | $7,838.38 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $3,944.41 / $13,658.46 / $21,194.66
| Facility | | $3,944.41 | $13,658.46 | $21,194.66 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $3,800.00 / $3,800.00 / $3,800.00
| Facility | | $3,800.00 | $3,800.00 | $3,800.00 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $789.23 / $1,039.22 / $2,100.00
| Facility | | $789.23 | $1,039.22 | $2,100.00 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $790.00 / $7,773.00 / $13,891.00
| Facility | | $790.00 | $7,773.00 | $13,891.00 |