- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $666.00 / $1,520.00 / $4,050.00
| Facility | | $666.00 | $1,520.00 | $4,050.00 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $34,864.74 / $62,835.33 / $108,149.07
| Facility | | $34,864.74 | $62,835.33 | $108,149.07 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $640.03 / $27,856.61 / $27,856.61
| Facility | | $640.03 | $27,856.61 | $27,856.61 |
- 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
- $1,975.00 / $20,837.00 / $60,637.00
| Facility | | $1,975.00 | $20,837.00 | $60,637.00 |