- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $794.33 / $3,162.28 / $7,943.28
| Facility | | $794.33 | $3,162.28 | $7,943.28 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2,818.38 / $4,897.79 / $9,772.37
| Facility | | $2,818.38 | $4,897.79 | $9,772.37 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $562.34 / $562.34 / $562.34
| Facility | | $562.34 | $562.34 | $562.34 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2,398.83 / $2,398.83 / $2,398.83
| Facility | | $2,398.83 | $2,398.83 | $2,398.83 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $9,332.54 / $28,840.32 / $28,840.32
| Facility | | $9,332.54 | $28,840.32 | $28,840.32 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $630.96 / $1,000.00 / $4,365.16
| Facility | | $630.96 | $1,000.00 | $4,365.16 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $602.56 / $831.76 / $1,445.44
| Facility | | $602.56 | $831.76 | $1,445.44 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,698.24 / $5,248.07 / $10,964.78
| Facility | | $1,698.24 | $5,248.07 | $10,964.78 |