- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $860.00 / $2,476.87 / $8,229.00
| Facility | | $860.00 | $2,476.87 | $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
- $2,123.65 / $3,152.38 / $3,636.51
| Facility | | $2,123.65 | $3,152.38 | $3,636.51 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2,763.04 / $2,763.04 / $3,436.81
| Facility | | $2,763.04 | $2,763.04 | $3,436.81 |
- 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 |