- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $841.00 / $2,418.00 / $5,150.00
| Facility | | $841.00 | $2,418.00 | $5,150.00 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $4,062.09 / $7,362.58 / $14,106.04
| Facility | | $4,062.09 | $7,362.58 | $14,106.04 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $40.00 / $40.00 / $746.14
| Facility | | $40.00 | $40.00 | $746.14 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,400.00 / $1,400.00 / $1,400.00
| Facility | | $1,400.00 | $1,400.00 | $1,400.00 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $882.00 / $3,238.00 / $9,160.00
| Facility | | $882.00 | $3,238.00 | $9,160.00 |