- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,412.54 / $5,370.32 / $8,511.38
| Facility | | $1,412.54 | $5,370.32 | $8,511.38 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $3,801.89 / $4,466.84 / $57,543.99
| Facility | | $3,801.89 | $4,466.84 | $57,543.99 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $575.44 / $575.44 / $575.44
| Facility | | $575.44 | $575.44 | $575.44 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,023.29 / $4,786.30 / $8,511.38
| Facility | | $1,023.29 | $4,786.30 | $8,511.38 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $549.54 / $549.54 / $707.95
| Facility | | $549.54 | $549.54 | $707.95 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $331.13 / $588.84 / $588.84
| Facility | | $331.13 | $588.84 | $588.84 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $912.01 / $2,754.23 / $10,000.00
| Facility | | $912.01 | $2,754.23 | $10,000.00 |