- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $645.65 / $645.65 / $5,011.87
| Facility | | $645.65 | $645.65 | $5,011.87 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $4,073.80 / $7,585.78 / $15,135.61
| Facility | | $4,073.80 | $7,585.78 | $15,135.61 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,698.24 / $2,398.83 / $5,754.40
| Facility | | $1,698.24 | $2,398.83 | $5,754.40 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,819.70 / $2,344.23 / $4,466.84
| Facility | | $1,819.70 | $2,344.23 | $4,466.84 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $691.83 / $1,348.96 / $7,762.47
| Facility | | $691.83 | $1,348.96 | $7,762.47 |
- 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 |