- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $860.00 / $2,447.00 / $5,150.00
| Facility | | $860.00 | $2,447.00 | $5,150.00 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2,355.32 / $5,537.49 / $13,518.61
| Facility | | $2,355.32 | $5,537.49 | $13,518.61 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $40.00 / $40.00 / $922.36
| Facility | | $40.00 | $40.00 | $922.36 |
- 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
- $1,200.00 / $6,034.00 / $13,506.00
| Facility | | $1,200.00 | $6,034.00 | $13,506.00 |