- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $860.00 / $2,549.00 / $5,150.00
| Facility | | $860.00 | $2,549.00 | $5,150.00 |
- 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 / $1,454.72
| Facility | | $40.00 | $40.00 | $1,454.72 |
- 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
- $1,149.00 / $3,841.00 / $10,810.00
| Facility | | $1,149.00 | $3,841.00 | $10,810.00 |