- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $860.00 / $2,297.28 / $8,229.00
| Facility | | $860.00 | $2,297.28 | $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
- $1,795.60 / $2,449.03 / $2,825.13
| Facility | | $1,795.60 | $2,449.03 | $2,825.13 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2,154.05 / $2,154.05 / $2,741.36
| Facility | | $2,154.05 | $2,154.05 | $2,741.36 |
- 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 |