- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $756.00 / $2,397.00 / $4,392.00
| Facility | | $756.00 | $2,397.00 | $4,392.00 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $5,521.14 / $10,016.18 / $14,892.66
| Facility | | $5,521.14 | $10,016.18 | $14,892.66 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $40.00 / $40.00 / $879.56
| Facility | | $40.00 | $40.00 | $879.56 |
- 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
- $1,141.00 / $4,717.00 / $11,696.00
| Facility | | $1,141.00 | $4,717.00 | $11,696.00 |