- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $860.00 / $1,842.33 / $8,229.00
| Facility | | $860.00 | $1,842.33 | $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
- $1,569.40 / $2,344.79 / $2,704.88
| Facility | | $1,569.40 | $2,344.79 | $2,704.88 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2,060.39 / $2,060.39 / $2,303.42
| Facility | | $2,060.39 | $2,060.39 | $2,303.42 |
- 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 |