- 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
- $3,019.95 / $6,165.95 / $11,748.98
| Facility | | $3,019.95 | $6,165.95 | $11,748.98 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $549.54 / $5,248.07 / $5,248.07
| Facility | | $549.54 | $5,248.07 | $5,248.07 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $3,235.94 / $3,235.94 / $3,311.31
| Facility | | $3,235.94 | $3,235.94 | $3,311.31 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $14,791.08 / $33,884.42 / $33,884.42
| Facility | | $14,791.08 | $33,884.42 | $33,884.42 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $616.60 / $1,000.00 / $5,248.07
| Facility | | $616.60 | $1,000.00 | $5,248.07 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $602.56 / $758.58 / $1,288.25
| Facility | | $602.56 | $758.58 | $1,288.25 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,258.93 / $4,073.80 / $8,912.51
| Facility | | $1,258.93 | $4,073.80 | $8,912.51 |