- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $860.00 / $1,673.82 / $8,229.00
| Facility | | $860.00 | $1,673.82 | $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
- $1,637.81 / $2,233.64 / $2,576.67
| Facility | | $1,637.81 | $2,233.64 | $2,576.67 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,954.92 / $1,954.92 / $1,954.92
| Facility | | $1,954.92 | $1,954.92 | $1,954.92 |
- 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 |