- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $739.00 / $2,397.00 / $4,050.00
| Facility | | $739.00 | $2,397.00 | $4,050.00 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $6,429.16 / $16,692.36 / $38,321.62
| Facility | | $6,429.16 | $16,692.36 | $38,321.62 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $40.00 / $40.00 / $1,094.66
| Facility | | $40.00 | $40.00 | $1,094.66 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,350.00 / $1,350.00 / $1,350.00
| Facility | | $1,350.00 | $1,350.00 | $1,350.00 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,200.00 / $5,780.00 / $13,506.00
| Facility | | $1,200.00 | $5,780.00 | $13,506.00 |