- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $860.00 / $1,828.41 / $8,229.00
| Facility | | $860.00 | $1,828.41 | $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
- $1,535.55 / $2,092.71 / $2,414.10
| Facility | | $1,535.55 | $2,092.71 | $2,414.10 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,826.40 / $1,826.40 / $2,181.85
| Facility | | $1,826.40 | $1,826.40 | $2,181.85 |
- 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 |