- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $860.00 / $1,740.56 / $8,229.00
| Facility | | $860.00 | $1,740.56 | $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
- $1,254.31 / $1,710.97 / $1,973.72
| Facility | | $1,254.31 | $1,710.97 | $1,973.72 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,506.16 / $1,506.16 / $2,077.02
| Facility | | $1,506.16 | $1,506.16 | $2,077.02 |
- 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 |