- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $860.00 / $1,685.60 / $8,229.00
| Facility | | $860.00 | $1,685.60 | $8,229.00 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $7,212.00 / $9,592.68 / $21,957.82
| Facility | | $7,212.00 | $9,592.68 | $21,957.82 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,386.65 / $1,903.24 / $2,195.53
| Facility | | $1,386.65 | $1,903.24 | $2,195.53 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,419.28 / $1,671.52 / $1,671.52
| Facility | | $1,419.28 | $1,671.52 | $1,671.52 |
- 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 |