- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $776.25 / $776.25 / $2,630.27
| Facility | | $776.25 | $776.25 | $2,630.27 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $4,677.35 / $8,317.64 / $19,054.61
| Facility | | $4,677.35 | $8,317.64 | $19,054.61 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,862.09 / $2,951.21 / $7,079.46
| Facility | | $1,862.09 | $2,951.21 | $7,079.46 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2,290.87 / $2,884.03 / $5,495.41
| Facility | | $2,290.87 | $2,884.03 | $5,495.41 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $812.83 / $1,348.96 / $3,981.07
| Facility | | $812.83 | $1,348.96 | $3,981.07 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2,089.30 / $5,011.87 / $10,000.00
| Facility | | $2,089.30 | $5,011.87 | $10,000.00 |