- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $630.84 / $1,850.00 / $3,884.00
| Facility | | $630.84 | $1,850.00 | $3,884.00 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $5,685.25 / $9,654.96 / $13,982.44
| Facility | | $5,685.25 | $9,654.96 | $13,982.44 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $7,065.59 / $7,065.59 / $7,065.59
| Facility | | $7,065.59 | $7,065.59 | $7,065.59 |
- 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 |