- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $900.00 / $2,694.00 / $5,432.00
| Facility | | $900.00 | $2,694.00 | $5,432.00 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $3,461.26 / $19,926.55 / $29,628.01
| Facility | | $3,461.26 | $19,926.55 | $29,628.01 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $40.00 / $40.00 / $1,400.09
| Facility | | $40.00 | $40.00 | $1,400.09 |
- 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
- $1,150.00 / $5,780.00 / $13,506.00
| Facility | | $1,150.00 | $5,780.00 | $13,506.00 |