- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $512.86 / $2,290.87 / $6,918.31
| Facility | | $512.86 | $2,290.87 | $6,918.31 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,318.26 / $2,691.53 / $4,073.80
| Facility | | $1,318.26 | $2,691.53 | $4,073.80 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $52.48 / $52.48 / $52.48
| Facility | | $52.48 | $52.48 | $52.48 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $54.95 / $56.23 / $1,445.44
| Facility | | $54.95 | $56.23 | $1,445.44 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $67.61 / $1,000.00 / $4,677.35
| Facility | | $67.61 | $1,000.00 | $4,677.35 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $56.23 / $389.05 / $1,000.00
| Facility | | $56.23 | $389.05 | $1,000.00 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $154.88 / $1,047.13 / $2,691.53
| Facility | | $154.88 | $1,047.13 | $2,691.53 |