- 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
- $5,714.00 / $9,603.49 / $17,123.47
| Facility | | $5,714.00 | $9,603.49 | $17,123.47 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,081.71 / $1,147.91 / $1,147.91
| Facility | | $1,081.71 | $1,147.91 | $1,147.91 |
- 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 / $4,717.00 / $11,696.00
| Facility | | $1,141.00 | $4,717.00 | $11,696.00 |