- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $125.89 / $234.42 / $3,162.28
| Facility | | $125.89 | $234.42 | $3,162.28 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $758.58 / $6,606.93 / $15,848.93
| Facility | | $758.58 | $6,606.93 | $15,848.93 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $954.99 / $1,348.96 / $3,235.94
| Facility | | $954.99 | $1,348.96 | $3,235.94 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,047.13 / $1,288.25 / $2,511.89
| Facility | | $1,047.13 | $1,288.25 | $2,511.89 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $177.83 / $457.09 / $3,311.31
| Facility | | $177.83 | $457.09 | $3,311.31 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $3,090.30 / $6,760.83 / $10,000.00
| Facility | | $3,090.30 | $6,760.83 | $10,000.00 |