- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $830.07 / $2,500.00 / $4,050.00
| Facility | | $830.07 | $2,500.00 | $4,050.00 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $5,898.80 / $10,537.20 / $15,036.83
| Facility | | $5,898.80 | $10,537.20 | $15,036.83 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $587.12 / $603.78 / $603.78
| Facility | | $587.12 | $603.78 | $603.78 |
- 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 |