- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $900.00 / $2,500.00 / $4,050.00
| Facility | | $900.00 | $2,500.00 | $4,050.00 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $6,291.82 / $10,814.26 / $15,036.83
| Facility | | $6,291.82 | $10,814.26 | $15,036.83 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $40.00 / $40.00 / $1,052.72
| Facility | | $40.00 | $40.00 | $1,052.72 |
- 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 |