- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,000.00 / $1,737.80 / $3,467.37
| Facility | | $1,000.00 | $1,737.80 | $3,467.37 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $85.11 / $1,621.81 / $5,011.87
| Facility | | $85.11 | $1,621.81 | $5,011.87 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2,570.40 / $2,570.40 / $2,570.40
| Facility | | $2,570.40 | $2,570.40 | $2,570.40 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,000.00 / $1,737.80 / $2,454.71
| Facility | | $1,000.00 | $1,737.80 | $2,454.71 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $870.96 / $1,023.29 / $1,513.56
| Facility | | $870.96 | $1,023.29 | $1,513.56 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,000.00 / $1,096.48 / $1,513.56
| Facility | | $1,000.00 | $1,096.48 | $1,513.56 |