- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,213.00 / $3,843.00 / $12,154.00
| Facility | | $1,213.00 | $3,843.00 | $12,154.00 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,168.30 / $1,632.85 / $14,625.00
| Facility | | $1,168.30 | $1,632.85 | $14,625.00 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $442.00 / $8,996.00 / $8,996.00
| Facility | | $442.00 | $8,996.00 | $8,996.00 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $385.05 / $635.40 / $22,466.00
| Facility | | $385.05 | $635.40 | $22,466.00 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $4,096.00 / $11,544.00 / $22,466.00
| Facility | | $4,096.00 | $11,544.00 | $22,466.00 |