- 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
- $5,114.57 / $8,634.94 / $14,106.04
| Facility | | $5,114.57 | $8,634.94 | $14,106.04 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,063.58 / $1,144.04 / $1,144.04
| Facility | | $1,063.58 | $1,144.04 | $1,144.04 |
- 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 |