- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,000.00 / $7,838.38 / $8,644.27
| Facility | | $1,000.00 | $7,838.38 | $8,644.27 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $4,040.74 / $13,992.02 / $21,712.27
| Facility | | $4,040.74 | $13,992.02 | $21,712.27 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $4,500.00 / $4,500.00 / $4,500.00
| Facility | | $4,500.00 | $4,500.00 | $4,500.00 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,108.36 / $1,456.97 / $2,625.00
| Facility | | $1,108.36 | $1,456.97 | $2,625.00 |
- 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 |