- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $860.00 / $2,207.60 / $8,229.00
| Facility | | $860.00 | $2,207.60 | $8,229.00 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $7,062.90 / $9,565.00 / $21,322.13
| Facility | | $7,062.90 | $9,565.00 | $21,322.13 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2,055.36 / $2,809.67 / $3,241.15
| Facility | | $2,055.36 | $2,809.67 | $3,241.15 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2,250.55 / $2,476.69 / $2,476.69
| Facility | | $2,250.55 | $2,476.69 | $2,476.69 |
- 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 |