- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,000.00 / $5,000.27 / $7,838.38
| Facility | | $1,000.00 | $5,000.27 | $7,838.38 |
- 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
- $1,300.00 / $1,300.00 / $1,300.00
| Facility | | $1,300.00 | $1,300.00 | $1,300.00 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $911.32 / $1,202.94 / $1,365.00
| Facility | | $911.32 | $1,202.94 | $1,365.00 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $790.00 / $7,773.00 / $13,891.00
| Facility | | $790.00 | $7,773.00 | $13,891.00 |