- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $787.00 / $1,408.42 / $8,229.00
| Facility | | $787.00 | $1,408.42 | $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
- $1,409.60 / $1,934.74 / $2,231.87
| Facility | | $1,409.60 | $1,934.74 | $2,231.87 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,686.78 / $1,686.78 / $1,686.78
| Facility | | $1,686.78 | $1,686.78 | $1,686.78 |
- 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 |