- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $860.00 / $1,626.97 / $8,229.00
| Facility | | $860.00 | $1,626.97 | $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
- $1,533.56 / $2,070.67 / $2,388.67
| Facility | | $1,533.56 | $2,070.67 | $2,388.67 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,808.59 / $1,808.59 / $2,137.69
| Facility | | $1,808.59 | $1,808.59 | $2,137.69 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $523.00 / $1,450.00 / $5,301.00
| Facility | | $523.00 | $1,450.00 | $5,301.00 |