- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $900.00 / $2,694.00 / $5,604.00
| Facility | | $900.00 | $2,694.00 | $5,604.00 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $5,173.56 / $12,538.59 / $26,894.41
| Facility | | $5,173.56 | $12,538.59 | $26,894.41 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $40.00 / $40.00 / $695.67
| Facility | | $40.00 | $40.00 | $695.67 |
- 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
- $1,305.00 / $7,102.00 / $22,240.00
| Facility | | $1,305.00 | $7,102.00 | $22,240.00 |