- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $860.00 / $1,837.53 / $8,229.00
| Facility | | $860.00 | $1,837.53 | $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
- $1,495.28 / $2,038.72 / $2,351.82
| Facility | | $1,495.28 | $2,038.72 | $2,351.82 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,783.39 / $1,783.39 / $2,192.73
| Facility | | $1,783.39 | $1,783.39 | $2,192.73 |
- 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 |