- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $860.00 / $1,678.72 / $8,229.00
| Facility | | $860.00 | $1,678.72 | $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
- $1,307.30 / $1,782.19 / $2,055.88
| Facility | | $1,307.30 | $1,782.19 | $2,055.88 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,568.74 / $1,568.74 / $2,003.22
| Facility | | $1,568.74 | $1,568.74 | $2,003.22 |
- 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 |