- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,000.00 / $3,162.28 / $6,606.93
| Facility | | $1,000.00 | $3,162.28 | $6,606.93 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2,187.76 / $3,890.45 / $5,888.44
| Facility | | $2,187.76 | $3,890.45 | $5,888.44 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $39.81 / $1,949.84 / $1,949.84
| Facility | | $39.81 | $1,949.84 | $1,949.84 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,122.02 / $1,122.02 / $1,122.02
| Facility | | $1,122.02 | $1,122.02 | $1,122.02 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $831.76 / $2,570.40 / $6,165.95
| Facility | | $831.76 | $2,570.40 | $6,165.95 |