- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $900.00 / $2,694.00 / $5,604.00
| Facility | | $900.00 | $2,694.00 | $5,604.00 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $7,012.47 / $13,548.82 / $26,517.16
| Facility | | $7,012.47 | $13,548.82 | $26,517.16 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,465.23 / $23,873.14 / $23,873.14
| Facility | | $1,465.23 | $23,873.14 | $23,873.14 |
- 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 / $22,109.00
| Facility | | $1,215.00 | $9,403.00 | $22,109.00 |