- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $860.00 / $1,926.33 / $8,229.00
| Facility | | $860.00 | $1,926.33 | $8,229.00 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $5,470.00 / $8,584.00 / $11,253.00
| Facility | | $5,470.00 | $8,584.00 | $11,253.00 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,880.67 / $2,563.71 / $2,957.45
| Facility | | $1,880.67 | $2,563.71 | $2,957.45 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,726.75 / $2,253.42 / $2,253.42
| Facility | | $1,726.75 | $2,253.42 | $2,253.42 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $599.00 / $4,298.00 / $30,001.00
| Facility | | $599.00 | $4,298.00 | $30,001.00 |