- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $860.00 / $2,244.02 / $8,229.00
| Facility | | $860.00 | $2,244.02 | $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
- $2,080.82 / $2,856.03 / $3,294.64
| Facility | | $2,080.82 | $2,856.03 | $3,294.64 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2,511.41 / $2,511.41 / $2,892.14
| Facility | | $2,511.41 | $2,511.41 | $2,892.14 |
- 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 |