- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $323.59 / $2,884.03 / $6,025.60
| Facility | | $323.59 | $2,884.03 | $6,025.60 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $812.83 / $11,220.18 / $26,302.68
| Facility | | $812.83 | $11,220.18 | $26,302.68 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $7,244.36 / $10,471.29 / $25,118.86
| Facility | | $7,244.36 | $10,471.29 | $25,118.86 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $8,128.31 / $10,000.00 / $19,952.62
| Facility | | $8,128.31 | $10,000.00 | $19,952.62 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $512.86 / $4,570.88 / $12,022.64
| Facility | | $512.86 | $4,570.88 | $12,022.64 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $4,897.79 / $10,000.00 / $15,135.61
| Facility | | $4,897.79 | $10,000.00 | $15,135.61 |