- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $860.00 / $1,485.03 / $8,229.00
| Facility | | $860.00 | $1,485.03 | $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
- $1,472.69 / $1,988.69 / $2,294.10
| Facility | | $1,472.69 | $1,988.69 | $2,294.10 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,749.16 / $1,749.16 / $1,806.46
| Facility | | $1,749.16 | $1,749.16 | $1,806.46 |
- 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 |