- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $941.00 / $2,636.00 / $5,432.00
| Facility | | $941.00 | $2,636.00 | $5,432.00 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $3,526.19 / $11,950.69 / $26,517.16
| Facility | | $3,526.19 | $11,950.69 | $26,517.16 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $454.68 / $454.68 / $454.68
| Facility | | $454.68 | $454.68 | $454.68 |
- 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
- $1,215.00 / $9,403.00 / $24,051.00
| Facility | | $1,215.00 | $9,403.00 | $24,051.00 |