- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $900.00 / $2,562.00 / $5,432.00
| Facility | | $900.00 | $2,562.00 | $5,432.00 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $6,066.13 / $10,303.91 / $15,823.46
| Facility | | $6,066.13 | $10,303.91 | $15,823.46 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $892.65 / $7,544.63 / $7,544.63
| Facility | | $892.65 | $7,544.63 | $7,544.63 |
- 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 |