- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $860.00 / $2,447.00 / $5,150.00
| Facility | | $860.00 | $2,447.00 | $5,150.00 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2,238.19 / $3,762.63 / $5,613.80
| Facility | | $2,238.19 | $3,762.63 | $5,613.80 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $895.03 / $908.97 / $908.97
| Facility | | $895.03 | $908.97 | $908.97 |
- 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 |