- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $941.00 / $2,859.00 / $5,432.00
| Facility | | $941.00 | $2,859.00 | $5,432.00 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $4,885.05 / $9,971.73 / $15,700.73
| Facility | | $4,885.05 | $9,971.73 | $15,700.73 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $40.00 / $40.00 / $40.00
| Facility | | $40.00 | $40.00 | $40.00 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $5,656.00 / $8,813.00 / $19,124.00
| Facility | | $5,656.00 | $8,813.00 | $19,124.00 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,284.00 / $6,711.00 / $12,805.00
| Facility | | $1,284.00 | $6,711.00 | $12,805.00 |