- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $941.00 / $2,859.00 / $5,608.00
| Facility | | $941.00 | $2,859.00 | $5,608.00 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $10,862.06 / $19,626.43 / $38,321.62
| Facility | | $10,862.06 | $19,626.43 | $38,321.62 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $40.00 / $40.00 / $1,270.49
| Facility | | $40.00 | $40.00 | $1,270.49 |
- 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
- $1,449.00 / $10,675.00 / $38,889.00
| Facility | | $1,449.00 | $10,675.00 | $38,889.00 |