- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $941.00 / $2,972.77 / $6,012.00
| Facility | | $941.00 | $2,972.77 | $6,012.00 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $11,310.43 / $20,353.22 / $27,742.59
| Facility | | $11,310.43 | $20,353.22 | $27,742.59 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,652.51 / $19,378.48 / $19,378.48
| Facility | | $1,652.51 | $19,378.48 | $19,378.48 |
- 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 / $12,200.00 / $26,848.00
| Facility | | $1,200.00 | $12,200.00 | $26,848.00 |