- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $900.00 / $2,500.00 / $5,150.00
| Facility | | $900.00 | $2,500.00 | $5,150.00 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $4,783.10 / $8,674.20 / $11,969.08
| Facility | | $4,783.10 | $8,674.20 | $11,969.08 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,071.58 / $1,560.51 / $1,560.51
| Facility | | $1,071.58 | $1,560.51 | $1,560.51 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,400.00 / $1,400.00 / $1,400.00
| Facility | | $1,400.00 | $1,400.00 | $1,400.00 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,141.00 / $4,717.00 / $11,696.00
| Facility | | $1,141.00 | $4,717.00 | $11,696.00 |