- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $7,762.47 / $10,000.00 / $10,000.00
| Facility | | $7,762.47 | $10,000.00 | $10,000.00 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $5,248.07 / $7,079.46 / $12,882.50
| Facility | | $5,248.07 | $7,079.46 | $12,882.50 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,737.80 / $1,949.84 / $12,882.50
| Facility | | $1,737.80 | $1,949.84 | $12,882.50 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $54.95 / $95.50 / $147.91
| Facility | | $54.95 | $95.50 | $147.91 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $11,481.54 / $14,791.08 / $14,791.08
| Facility | | $11,481.54 | $14,791.08 | $14,791.08 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $4,677.35 / $5,623.41 / $6,456.54
| Facility | | $4,677.35 | $5,623.41 | $6,456.54 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $660.69 / $8,912.51 / $10,964.78
| Facility | | $660.69 | $8,912.51 | $10,964.78 |