- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $860.00 / $1,404.19 / $8,229.00
| Facility | | $860.00 | $1,404.19 | $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
- $1,145.63 / $1,562.25 / $1,802.17
| Facility | | $1,145.63 | $1,562.25 | $1,802.17 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,393.54 / $1,393.54 / $1,675.63
| Facility | | $1,393.54 | $1,393.54 | $1,675.63 |
- 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 |