- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $900.00 / $2,636.00 / $4,050.00
| Facility | | $900.00 | $2,636.00 | $4,050.00 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $6,261.91 / $10,697.52 / $15,036.83
| Facility | | $6,261.91 | $10,697.52 | $15,036.83 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $40.00 / $40.00 / $1,362.82
| Facility | | $40.00 | $40.00 | $1,362.82 |
- 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
- $385.00 / $1,309.00 / $6,699.00
| Facility | | $385.00 | $1,309.00 | $6,699.00 |