- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $758.24 / $925.76 / $1,114.77
| Facility | | $758.24 | $925.76 | $1,114.77 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $4,149.79 / $8,584.00 / $13,733.40
| Facility | | $4,149.79 | $8,584.00 | $13,733.40 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $841.60 / $1,178.24 / $1,388.64
| Facility | | $841.60 | $1,178.24 | $1,388.64 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,040.04 / $1,040.04 / $1,213.93
| Facility | | $1,040.04 | $1,040.04 | $1,213.93 |
- 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 |