- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $860.00 / $2,093.63 / $8,229.00
| Facility | | $860.00 | $2,093.63 | $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
- $1,973.35 / $2,664.62 / $3,073.84
| Facility | | $1,973.35 | $2,664.62 | $3,073.84 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2,340.80 / $2,340.80 / $2,615.67
| Facility | | $2,340.80 | $2,340.80 | $2,615.67 |
- 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 |