- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $900.00 / $2,753.09 / $4,050.00
| Facility | | $900.00 | $2,753.09 | $4,050.00 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $6,319.33 / $10,579.13 / $14,892.66
| Facility | | $6,319.33 | $10,579.13 | $14,892.66 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $40.00 / $40.00 / $1,613.75
| Facility | | $40.00 | $40.00 | $1,613.75 |
- 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 |