- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,474.00 / $3,600.00 / $10,439.00
| Facility | | $1,474.00 | $3,600.00 | $10,439.00 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2,326.27 / $2,326.27 / $2,326.27
| Facility | | $2,326.27 | $2,326.27 | $2,326.27 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $596.00 / $2,341.00 / $2,341.00
| Facility | | $596.00 | $2,341.00 | $2,341.00 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $539.20 / $808.67 / $5,273.00
| Facility | | $539.20 | $808.67 | $5,273.00 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,405.00 / $3,647.00 / $6,988.00
| Facility | | $1,405.00 | $3,647.00 | $6,988.00 |