- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $841.00 / $2,418.00 / $5,432.00
| Facility | | $841.00 | $2,418.00 | $5,432.00 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $10,324.49 / $17,626.14 / $26,517.16
| Facility | | $10,324.49 | $17,626.14 | $26,517.16 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $618.98 / $12,237.01 / $12,237.01
| Facility | | $618.98 | $12,237.01 | $12,237.01 |
- 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
- $1,215.00 / $8,932.00 / $22,109.00
| Facility | | $1,215.00 | $8,932.00 | $22,109.00 |