- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $941.00 / $2,694.00 / $5,604.00
| Facility | | $941.00 | $2,694.00 | $5,604.00 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $5,636.68 / $12,435.05 / $27,360.92
| Facility | | $5,636.68 | $12,435.05 | $27,360.92 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $258.38 / $258.38 / $258.38
| Facility | | $258.38 | $258.38 | $258.38 |
- 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 / $9,403.00 / $23,200.00
| Facility | | $1,215.00 | $9,403.00 | $23,200.00 |