- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $900.00 / $3,101.00 / $5,604.00
| Facility | | $900.00 | $3,101.00 | $5,604.00 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $16,692.36 / $28,516.37 / $40,083.66
| Facility | | $16,692.36 | $28,516.37 | $40,083.66 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $40.00 / $40.00 / $2,165.96
| Facility | | $40.00 | $40.00 | $2,165.96 |
- 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
- $1,215.00 / $9,403.00 / $22,109.00
| Facility | | $1,215.00 | $9,403.00 | $22,109.00 |