- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $860.00 / $2,500.00 / $5,687.00
| Facility | | $860.00 | $2,500.00 | $5,687.00 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $12,457.66 / $21,282.04 / $29,914.81
| Facility | | $12,457.66 | $21,282.04 | $29,914.81 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $40.00 / $40.00 / $1,072.78
| Facility | | $40.00 | $40.00 | $1,072.78 |
- 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 |