- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,023.00 / $3,701.00 / $10,439.00
| Facility | | $1,023.00 | $3,701.00 | $10,439.00 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,098.20 / $1,804.82 / $2,568.26
| Facility | | $1,098.20 | $1,804.82 | $2,568.26 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $9,690.00 / $9,690.00 / $9,690.00
| Facility | | $9,690.00 | $9,690.00 | $9,690.00 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $178.60 / $464.74 / $3,331.00
| Facility | | $178.60 | $464.74 | $3,331.00 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $825.00 / $2,081.00 / $3,918.00
| Facility | | $825.00 | $2,081.00 | $3,918.00 |