- 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
- $5,632.32 / $16,692.36 / $38,321.62
| Facility | | $5,632.32 | $16,692.36 | $38,321.62 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $40.00 / $40.00 / $1,248.27
| Facility | | $40.00 | $40.00 | $1,248.27 |
- 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
- $1,215.00 / $9,403.00 / $22,109.00
| Facility | | $1,215.00 | $9,403.00 | $22,109.00 |