- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $941.00 / $2,694.00 / $5,604.00
| Facility | | $941.00 | $2,694.00 | $5,604.00 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $7,664.45 / $14,039.55 / $26,517.16
| Facility | | $7,664.45 | $14,039.55 | $26,517.16 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,180.42 / $15,484.18 / $15,484.18
| Facility | | $1,180.42 | $15,484.18 | $15,484.18 |
- 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 |