- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $860.00 / $1,700.71 / $8,229.00
| Facility | | $860.00 | $1,700.71 | $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
- $1,290.38 / $1,759.46 / $2,029.68
| Facility | | $1,290.38 | $1,759.46 | $2,029.68 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,561.45 / $1,561.45 / $2,029.47
| Facility | | $1,561.45 | $1,561.45 | $2,029.47 |
- 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 |