- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $860.00 / $2,166.15 / $8,229.00
| Facility | | $860.00 | $2,166.15 | $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
- $1,837.63 / $2,756.92 / $3,180.32
| Facility | | $1,837.63 | $2,756.92 | $3,180.32 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2,428.81 / $2,428.81 / $2,739.35
| Facility | | $2,428.81 | $2,428.81 | $2,739.35 |
- 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 |