- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,318.26 / $4,897.79 / $16,595.87
| Facility | | $1,318.26 | $4,897.79 | $16,595.87 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,412.54 / $3,467.37 / $6,309.57
| Facility | | $1,412.54 | $3,467.37 | $6,309.57 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $371.54 / $575.44 / $1,380.38
| Facility | | $371.54 | $575.44 | $1,380.38 |
- Facility/Professional
- Facility
- Modifier
- 54
- Low / Median / High Price
- $588.84 / $588.84 / $588.84
| Facility | 54 | $588.84 | $588.84 | $588.84 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $776.25 / $776.25 / $1,148.15
| Professional | | $776.25 | $776.25 | $1,148.15 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $478.63 / $630.96 / $1,071.52
| Facility | | $478.63 | $630.96 | $1,071.52 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,479.11 / $6,760.83 / $10,000.00
| Facility | | $1,479.11 | $6,760.83 | $10,000.00 |