- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $860.00 / $1,960.65 / $8,229.00
| Facility | | $860.00 | $1,960.65 | $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
- $1,626.61 / $2,217.77 / $2,558.35
| Facility | | $1,626.61 | $2,217.77 | $2,558.35 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,963.45 / $1,963.45 / $2,339.65
| Facility | | $1,963.45 | $1,963.45 | $2,339.65 |
- 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 |