- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $630.96 / $630.96 / $5,011.87
| Facility | | $630.96 | $630.96 | $5,011.87 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $3,630.78 / $7,585.78 / $14,791.08
| Facility | | $3,630.78 | $7,585.78 | $14,791.08 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,621.81 / $2,290.87 / $5,495.41
| Facility | | $1,621.81 | $2,290.87 | $5,495.41 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,778.28 / $2,238.72 / $4,265.80
| Facility | | $1,778.28 | $2,238.72 | $4,265.80 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $630.96 / $1,202.26 / $7,413.10
| Facility | | $630.96 | $1,202.26 | $7,413.10 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2,818.38 / $5,011.87 / $10,000.00
| Facility | | $2,818.38 | $5,011.87 | $10,000.00 |