- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $860.00 / $2,783.23 / $8,229.00
| Facility | | $860.00 | $2,783.23 | $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
- $2,792.59 / $3,773.24 / $4,352.68
| Facility | | $2,792.59 | $3,773.24 | $4,352.68 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $3,310.30 / $3,310.30 / $3,540.60
| Facility | | $3,310.30 | $3,310.30 | $3,540.60 |
- 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 |