- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $860.00 / $2,500.00 / $5,150.00
| Facility | | $860.00 | $2,500.00 | $5,150.00 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $4,085.08 / $7,319.51 / $13,518.61
| Facility | | $4,085.08 | $7,319.51 | $13,518.61 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,193.13 / $1,403.84 / $1,403.84
| Facility | | $1,193.13 | $1,403.84 | $1,403.84 |
- 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
- $1,141.00 / $4,913.00 / $11,696.00
| Facility | | $1,141.00 | $4,913.00 | $11,696.00 |