- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $640.00 / $2,397.00 / $4,392.00
| Facility | | $640.00 | $2,397.00 | $4,392.00 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2,988.80 / $10,016.18 / $14,892.66
| Facility | | $2,988.80 | $10,016.18 | $14,892.66 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $40.00 / $40.00 / $486.70
| Facility | | $40.00 | $40.00 | $486.70 |
- 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
- $1,100.00 / $4,717.00 / $11,696.00
| Facility | | $1,100.00 | $4,717.00 | $11,696.00 |