- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $678.00 / $2,447.00 / $5,260.00
| Facility | | $678.00 | $2,447.00 | $5,260.00 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $11,142.44 / $19,262.49 / $28,063.06
| Facility | | $11,142.44 | $19,262.49 | $28,063.06 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $11,391.30 / $11,391.30 / $11,391.30
| Facility | | $11,391.30 | $11,391.30 | $11,391.30 |
- 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
- $1,305.00 / $7,100.00 / $22,240.00
| Facility | | $1,305.00 | $7,100.00 | $22,240.00 |