- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $941.00 / $2,887.29 / $7,240.00
| Facility | | $941.00 | $2,887.29 | $7,240.00 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $16,142.40 / $29,696.38 / $45,604.56
| Facility | | $16,142.40 | $29,696.38 | $45,604.56 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,480.68 / $20,850.66 / $20,850.66
| Facility | | $1,480.68 | $20,850.66 | $20,850.66 |
- 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
- $1,305.00 / $7,102.00 / $22,240.00
| Facility | | $1,305.00 | $7,102.00 | $22,240.00 |