- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $688.62 / $1,002.06 / $6,953.60
| Facility | | $688.62 | $1,002.06 | $6,953.60 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,703.55 / $1,703.55 / $1,728.40
| Facility | | $1,703.55 | $1,703.55 | $1,728.40 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $395.75 / $395.75 / $2,710.28
| Facility | | $395.75 | $395.75 | $2,710.28 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $617.02 / $742.00 / $1,222.97
| Facility | | $617.02 | $742.00 | $1,222.97 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,661.00 / $7,659.00 / $10,502.00
| Facility | | $1,661.00 | $7,659.00 | $10,502.00 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2,538.76 / $8,957.00 / $12,000.00
| Facility | | $2,538.76 | $8,957.00 | $12,000.00 |