- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,000.00 / $7,838.38 / $8,763.29
| Facility | | $1,000.00 | $7,838.38 | $8,763.29 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $4,225.89 / $15,495.55 / $25,249.78
| Facility | | $4,225.89 | $15,495.55 | $25,249.78 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $6,700.00 / $6,700.00 / $6,700.00
| Facility | | $6,700.00 | $6,700.00 | $6,700.00 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,132.66 / $1,132.66 / $6,700.00
| Facility | | $1,132.66 | $1,132.66 | $6,700.00 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $899.00 / $8,842.00 / $16,897.00
| Facility | | $899.00 | $8,842.00 | $16,897.00 |