- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $860.00 / $1,226.86 / $8,229.00
| Facility | | $860.00 | $1,226.86 | $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
- $1,195.34 / $1,630.26 / $1,880.62
| Facility | | $1,195.34 | $1,630.26 | $1,880.62 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,438.12 / $1,438.12 / $1,438.12
| Facility | | $1,438.12 | $1,438.12 | $1,438.12 |
- 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 |