- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $860.00 / $1,154.72 / $8,229.00
| Facility | | $860.00 | $1,154.72 | $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
- $1,082.72 / $1,469.65 / $1,695.35
| Facility | | $1,082.72 | $1,469.65 | $1,695.35 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,289.41 / $1,289.41 / $1,455.88
| Facility | | $1,289.41 | $1,289.41 | $1,455.88 |
- 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 |