- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $860.00 / $1,476.51 / $8,229.00
| Facility | | $860.00 | $1,476.51 | $8,229.00 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $4,503.33 / $8,584.00 / $13,595.06
| Facility | | $4,503.33 | $8,584.00 | $13,595.06 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,250.80 / $1,705.80 / $1,967.77
| Facility | | $1,250.80 | $1,705.80 | $1,967.77 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,408.37 / $1,501.85 / $1,501.85
| Facility | | $1,408.37 | $1,501.85 | $1,501.85 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $739.00 / $3,828.00 / $8,582.00
| Facility | | $739.00 | $3,828.00 | $8,582.00 |