- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $941.00 / $2,758.00 / $5,608.00
| Facility | | $941.00 | $2,758.00 | $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 / $1,026.95
| Facility | | $40.00 | $40.00 | $1,026.95 |
- 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 |