- 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
- $2,713.73 / $9,396.91 / $14,581.75
| Facility | | $2,713.73 | $9,396.91 | $14,581.75 |
- 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
- $858.77 / $1,044.31 / $2,350.00
| Facility | | $858.77 | $1,044.31 | $2,350.00 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $639.00 / $5,971.00 / $8,422.00
| Facility | | $639.00 | $5,971.00 | $8,422.00 |