- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $794.33 / $794.33 / $8,912.51
| Facility | | $794.33 | $794.33 | $8,912.51 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2,041.74 / $11,220.18 / $26,302.68
| Facility | | $2,041.74 | $11,220.18 | $26,302.68 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2,238.72 / $3,162.28 / $7,585.78
| Facility | | $2,238.72 | $3,162.28 | $7,585.78 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2,454.71 / $3,019.95 / $5,888.44
| Facility | | $2,454.71 | $3,019.95 | $5,888.44 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,148.15 / $1,949.84 / $12,022.64
| Facility | | $1,148.15 | $1,949.84 | $12,022.64 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $5,888.44 / $10,000.00 / $15,135.61
| Facility | | $5,888.44 | $10,000.00 | $15,135.61 |