- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $831.76 / $2,691.53 / $8,317.64
| Facility | | $831.76 | $2,691.53 | $8,317.64 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $5,011.87 / $5,248.07 / $57,543.99
| Facility | | $5,011.87 | $5,248.07 | $57,543.99 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,122.02 / $1,122.02 / $1,122.02
| Facility | | $1,122.02 | $1,122.02 | $1,122.02 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $10,964.78 / $10,964.78 / $10,964.78
| Facility | | $10,964.78 | $10,964.78 | $10,964.78 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $724.44 / $2,344.23 / $8,317.64
| Facility | | $724.44 | $2,344.23 | $8,317.64 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $562.34 / $562.34 / $1,513.56
| Facility | | $562.34 | $562.34 | $1,513.56 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $309.03 / $562.34 / $676.08
| Facility | | $309.03 | $562.34 | $676.08 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,348.96 / $3,548.13 / $10,000.00
| Facility | | $1,348.96 | $3,548.13 | $10,000.00 |