- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $831.76 / $3,388.44 / $7,943.28
| Facility | | $831.76 | $3,388.44 | $7,943.28 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $724.44 / $2,041.74 / $5,248.07
| Facility | | $724.44 | $2,041.74 | $5,248.07 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $5,754.40 / $10,000.00 / $14,791.08
| Facility | | $5,754.40 | $10,000.00 | $14,791.08 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $501.19 / $933.25 / $26,302.68
| Facility | | $501.19 | $933.25 | $26,302.68 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2,454.71 / $3,715.35 / $6,165.95
| Facility | | $2,454.71 | $3,715.35 | $6,165.95 |