- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $501.19 / $501.19 / $5,011.87
| Facility | | $501.19 | $501.19 | $5,011.87 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2,754.23 / $5,623.41 / $12,589.25
| Facility | | $2,754.23 | $5,623.41 | $12,589.25 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,318.26 / $1,862.09 / $4,365.16
| Facility | | $1,318.26 | $1,862.09 | $4,365.16 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,412.54 / $1,778.28 / $3,467.37
| Facility | | $1,412.54 | $1,778.28 | $3,467.37 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $524.81 / $1,023.29 / $7,244.36
| Facility | | $524.81 | $1,023.29 | $7,244.36 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $3,019.95 / $5,495.41 / $10,000.00
| Facility | | $3,019.95 | $5,495.41 | $10,000.00 |