- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $887.19 / $2,694.00 / $5,604.00
| Facility | | $887.19 | $2,694.00 | $5,604.00 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $3,732.97 / $12,538.59 / $26,894.41
| Facility | | $3,732.97 | $12,538.59 | $26,894.41 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $40.00 / $40.00 / $671.29
| Facility | | $40.00 | $40.00 | $671.29 |
- 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 |