- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $860.00 / $2,448.00 / $5,687.00
| Facility | | $860.00 | $2,448.00 | $5,687.00 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $11,735.29 / $19,926.55 / $28,758.35
| Facility | | $11,735.29 | $19,926.55 | $28,758.35 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,021.83 / $15,950.44 / $15,950.44
| Facility | | $1,021.83 | $15,950.44 | $15,950.44 |
- 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 / $23,200.00
| Facility | | $1,215.00 | $8,932.00 | $23,200.00 |