- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $860.00 / $2,448.00 / $5,150.00
| Facility | | $860.00 | $2,448.00 | $5,150.00 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $4,783.10 / $8,674.20 / $11,969.08
| Facility | | $4,783.10 | $8,674.20 | $11,969.08 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $40.00 / $40.00 / $1,016.67
| Facility | | $40.00 | $40.00 | $1,016.67 |
- 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 |