- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $794.33 / $2,818.38 / $9,772.37
| Facility | | $794.33 | $2,818.38 | $9,772.37 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,513.56 / $2,398.83 / $4,365.16
| Facility | | $1,513.56 | $2,398.83 | $4,365.16 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $776.25 / $1,071.52 / $1,380.38
| Facility | | $776.25 | $1,071.52 | $1,380.38 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,445.44 / $1,445.44 / $1,659.59
| Facility | | $1,445.44 | $1,445.44 | $1,659.59 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $851.14 / $4,677.35 / $10,000.00
| Facility | | $851.14 | $4,677.35 | $10,000.00 |