- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $860.00 / $1,464.84 / $8,229.00
| Facility | | $860.00 | $1,464.84 | $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
- $1,378.97 / $1,864.34 / $2,150.65
| Facility | | $1,378.97 | $1,864.34 | $2,150.65 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,626.32 / $1,626.32 / $1,900.27
| Facility | | $1,626.32 | $1,626.32 | $1,900.27 |
- 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 |