- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $860.00 / $2,448.00 / $5,150.00
| Facility | | $860.00 | $2,448.00 | $5,150.00 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $3,139.16 / $6,319.33 / $14,481.70
| Facility | | $3,139.16 | $6,319.33 | $14,481.70 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,063.28 / $1,110.42 / $1,110.42
| Facility | | $1,063.28 | $1,110.42 | $1,110.42 |
- 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 |