- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $900.00 / $2,562.00 / $5,203.00
| Facility | | $900.00 | $2,562.00 | $5,203.00 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $5,773.78 / $9,605.21 / $14,481.70
| Facility | | $5,773.78 | $9,605.21 | $14,481.70 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $40.00 / $40.00 / $740.01
| Facility | | $40.00 | $40.00 | $740.01 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,802.00 / $1,802.00 / $1,802.00
| Facility | | $1,802.00 | $1,802.00 | $1,802.00 |
- 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 |