- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $941.00 / $2,756.00 / $5,432.00
| Facility | | $941.00 | $2,756.00 | $5,432.00 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $7,215.68 / $13,323.02 / $26,517.16
| Facility | | $7,215.68 | $13,323.02 | $26,517.16 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,428.48 / $15,561.31 / $15,561.31
| Facility | | $1,428.48 | $15,561.31 | $15,561.31 |
- 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 / $5,780.00 / $13,506.00
| Facility | | $1,200.00 | $5,780.00 | $13,506.00 |