- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $860.00 / $1,646.66 / $8,229.00
| Facility | | $860.00 | $1,646.66 | $8,229.00 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $4,503.33 / $8,650.50 / $13,595.06
| Facility | | $4,503.33 | $8,650.50 | $13,595.06 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,297.38 / $1,780.72 / $2,054.19
| Facility | | $1,297.38 | $1,780.72 | $2,054.19 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,567.94 / $1,567.94 / $1,964.97
| Facility | | $1,567.94 | $1,567.94 | $1,964.97 |
- 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 |