- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $646.00 / $1,520.00 / $3,728.00
| Facility | | $646.00 | $1,520.00 | $3,728.00 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $6,261.91 / $10,697.52 / $15,036.83
| Facility | | $6,261.91 | $10,697.52 | $15,036.83 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $40.00 / $40.00 / $855.87
| Facility | | $40.00 | $40.00 | $855.87 |
- 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 |