- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $630.96 / $630.96 / $7,762.47
| Facility | | $630.96 | $630.96 | $7,762.47 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $15,135.61 / $26,915.35 / $81,283.05
| Facility | | $15,135.61 | $26,915.35 | $81,283.05 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,513.56 / $2,137.96 / $5,128.61
| Facility | | $1,513.56 | $2,137.96 | $5,128.61 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,659.59 / $2,041.74 / $3,981.07
| Facility | | $1,659.59 | $2,041.74 | $3,981.07 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $891.25 / $1,412.54 / $12,302.69
| Facility | | $891.25 | $1,412.54 | $12,302.69 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $4,897.79 / $10,000.00 / $28,840.32
| Facility | | $4,897.79 | $10,000.00 | $28,840.32 |