- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $900.00 / $2,562.00 / $5,526.00
| Facility | | $900.00 | $2,562.00 | $5,526.00 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $6,154.94 / $10,630.24 / $15,823.46
| Facility | | $6,154.94 | $10,630.24 | $15,823.46 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $907.46 / $11,749.75 / $11,749.75
| Facility | | $907.46 | $11,749.75 | $11,749.75 |
- 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
- $1,284.00 / $6,420.00 / $14,900.00
| Facility | | $1,284.00 | $6,420.00 | $14,900.00 |