- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $860.00 / $2,447.00 / $5,150.00
| Facility | | $860.00 | $2,447.00 | $5,150.00 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $3,381.62 / $6,487.42 / $14,481.70
| Facility | | $3,381.62 | $6,487.42 | $14,481.70 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $40.00 / $40.00 / $668.57
| Facility | | $40.00 | $40.00 | $668.57 |
- 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 |