- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,000.00 / $7,838.38 / $8,942.39
| Facility | | $1,000.00 | $7,838.38 | $8,942.39 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $4,040.74 / $14,816.60 / $24,143.45
| Facility | | $4,040.74 | $14,816.60 | $24,143.45 |
- 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
- $1,332.65 / $1,933.47 / $6,700.00
| Facility | | $1,332.65 | $1,933.47 | $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 |