- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $841.00 / $2,418.00 / $5,260.00
| Facility | | $841.00 | $2,418.00 | $5,260.00 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $5,300.52 / $12,429.60 / $27,360.92
| Facility | | $5,300.52 | $12,429.60 | $27,360.92 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $40.00 / $40.00 / $784.46
| Facility | | $40.00 | $40.00 | $784.46 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,400.00 / $1,400.00 / $1,400.00
| Facility | | $1,400.00 | $1,400.00 | $1,400.00 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,141.00 / $4,717.00 / $11,696.00
| Facility | | $1,141.00 | $4,717.00 | $11,696.00 |