- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $371.54 / $2,754.23 / $4,897.79
| Facility | | $371.54 | $2,754.23 | $4,897.79 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $870.96 / $5,128.61 / $28,840.32
| Facility | | $870.96 | $5,128.61 | $28,840.32 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $426.58 / $426.58 / $954.99
| Facility | | $426.58 | $426.58 | $954.99 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $363.08 / $776.25 / $7,079.46
| Facility | | $363.08 | $776.25 | $7,079.46 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,995.26 / $4,265.80 / $9,772.37
| Facility | | $1,995.26 | $4,265.80 | $9,772.37 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,513.56 / $1,513.56 / $2,951.21
| Facility | | $1,513.56 | $1,513.56 | $2,951.21 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $870.96 / $5,370.32 / $28,840.32
| Facility | | $870.96 | $5,370.32 | $28,840.32 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,862.09 / $4,265.80 / $10,000.00
| Facility | | $1,862.09 | $4,265.80 | $10,000.00 |