- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $860.00 / $2,230.36 / $8,229.00
| Facility | | $860.00 | $2,230.36 | $8,229.00 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $8,584.00 / $10,990.10 / $30,856.09
| Facility | | $8,584.00 | $10,990.10 | $30,856.09 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2,289.36 / $3,092.81 / $3,567.78
| Facility | | $2,289.36 | $3,092.81 | $3,567.78 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2,713.12 / $2,740.00 / $2,740.00
| Facility | | $2,713.12 | $2,740.00 | $2,740.00 |
- 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 |