- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $960.00 / $3,308.54 / $14,726.71
| Facility | | $960.00 | $3,308.54 | $14,726.71 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $11,735.29 / $20,809.80 / $28,828.86
| Facility | | $11,735.29 | $20,809.80 | $28,828.86 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,559.69 / $15,658.42 / $15,658.42
| Facility | | $1,559.69 | $15,658.42 | $15,658.42 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $400.00 / $400.00 / $400.00
| Facility | | $400.00 | $400.00 | $400.00 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,200.00 / $6,034.00 / $13,506.00
| Facility | | $1,200.00 | $6,034.00 | $13,506.00 |