- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $562.34 / $562.34 / $2,630.27
| Facility | | $562.34 | $562.34 | $2,630.27 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $3,311.31 / $7,943.28 / $17,378.01
| Facility | | $3,311.31 | $7,943.28 | $17,378.01 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,412.54 / $1,995.26 / $4,786.30
| Facility | | $1,412.54 | $1,995.26 | $4,786.30 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,548.82 / $1,949.84 / $3,801.89
| Facility | | $1,548.82 | $1,949.84 | $3,801.89 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $660.69 / $1,122.02 / $8,317.64
| Facility | | $660.69 | $1,122.02 | $8,317.64 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2,884.03 / $5,248.07 / $10,000.00
| Facility | | $2,884.03 | $5,248.07 | $10,000.00 |