- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $860.00 / $2,726.00 / $5,260.00
| Facility | | $860.00 | $2,726.00 | $5,260.00 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $8,398.09 / $17,443.11 / $23,641.08
| Facility | | $8,398.09 | $17,443.11 | $23,641.08 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $40.00 / $40.00 / $2,223.04
| Facility | | $40.00 | $40.00 | $2,223.04 |
- 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 |