- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $239.88 / $1,174.90 / $1,174.90
| Facility | | $239.88 | $1,174.90 | $1,174.90 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,584.89 / $6,760.83 / $16,218.10
| Facility | | $1,584.89 | $6,760.83 | $16,218.10 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2,691.53 / $4,365.16 / $10,471.29
| Facility | | $2,691.53 | $4,365.16 | $10,471.29 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $3,388.44 / $4,168.69 / $8,128.31
| Facility | | $3,388.44 | $4,168.69 | $8,128.31 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $281.84 / $1,174.90 / $3,311.31
| Facility | | $281.84 | $1,174.90 | $3,311.31 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,445.44 / $5,495.41 / $10,000.00
| Facility | | $1,445.44 | $5,495.41 | $10,000.00 |