- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $900.00 / $2,500.00 / $4,991.00
| Facility | | $900.00 | $2,500.00 | $4,991.00 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $6,131.83 / $10,475.11 / $15,823.46
| Facility | | $6,131.83 | $10,475.11 | $15,823.46 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $909.64 / $5,672.02 / $5,672.02
| Facility | | $909.64 | $5,672.02 | $5,672.02 |
- 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 |