- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,000.00 / $3,576.00 / $8,400.00
| Facility | | $1,000.00 | $3,576.00 | $8,400.00 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $6,089.88 / $9,700.70 / $15,488.78
| Facility | | $6,089.88 | $9,700.70 | $15,488.78 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,266.68 / $1,266.68 / $1,266.68
| Facility | | $1,266.68 | $1,266.68 | $1,266.68 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $846.82 / $1,807.00 / $5,703.80
| Facility | | $846.82 | $1,807.00 | $5,703.80 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,035.95 / $3,680.00 / $5,847.50
| Facility | | $1,035.95 | $3,680.00 | $5,847.50 |