- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $860.00 / $2,228.75 / $8,229.00
| Facility | | $860.00 | $2,228.75 | $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
- $1,732.69 / $2,363.63 / $2,726.61
| Facility | | $1,732.69 | $2,363.63 | $2,726.61 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2,089.21 / $2,089.21 / $2,659.57
| Facility | | $2,089.21 | $2,089.21 | $2,659.57 |
- 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 |