- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $416.87 / $562.34 / $562.34
| Facility | | $416.87 | $562.34 | $562.34 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2,454.71 / $7,585.78 / $17,378.01
| Facility | | $2,454.71 | $7,585.78 | $17,378.01 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,513.56 / $2,137.96 / $5,011.87
| Facility | | $1,513.56 | $2,137.96 | $5,011.87 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,621.81 / $2,041.74 / $3,981.07
| Facility | | $1,621.81 | $2,041.74 | $3,981.07 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $549.54 / $977.24 / $7,762.47
| Facility | | $549.54 | $977.24 | $7,762.47 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2,884.03 / $5,248.07 / $10,000.00
| Facility | | $2,884.03 | $5,248.07 | $10,000.00 |