- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $739.00 / $2,397.00 / $4,050.00
| Facility | | $739.00 | $2,397.00 | $4,050.00 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $6,880.28 / $16,662.06 / $36,661.62
| Facility | | $6,880.28 | $16,662.06 | $36,661.62 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $40.00 / $40.00 / $1,084.50
| Facility | | $40.00 | $40.00 | $1,084.50 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,350.00 / $1,350.00 / $1,350.00
| Facility | | $1,350.00 | $1,350.00 | $1,350.00 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,200.00 / $5,780.00 / $13,506.00
| Facility | | $1,200.00 | $5,780.00 | $13,506.00 |