- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $860.00 / $2,184.73 / $8,229.00
| Facility | | $860.00 | $2,184.73 | $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
- $2,037.27 / $2,780.57 / $3,207.58
| Facility | | $2,037.27 | $2,780.57 | $3,207.58 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2,446.75 / $2,446.75 / $2,738.14
| Facility | | $2,446.75 | $2,446.75 | $2,738.14 |
- 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 |