- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $860.00 / $2,500.00 / $5,432.00
| Facility | | $860.00 | $2,500.00 | $5,432.00 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $10,324.49 / $17,730.07 / $27,360.92
| Facility | | $10,324.49 | $17,730.07 | $27,360.92 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,061.89 / $11,427.88 / $11,427.88
| Facility | | $1,061.89 | $11,427.88 | $11,427.88 |
- 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
- $1,421.00 / $9,403.00 / $26,342.00
| Facility | | $1,421.00 | $9,403.00 | $26,342.00 |