- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $580.00 / $1,520.00 / $3,728.00
| Facility | | $580.00 | $1,520.00 | $3,728.00 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $3,128.76 / $5,963.37 / $12,665.76
| Facility | | $3,128.76 | $5,963.37 | $12,665.76 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2,031.25 / $2,031.25 / $2,031.25
| Facility | | $2,031.25 | $2,031.25 | $2,031.25 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,400.00 / $1,400.00 / $1,400.00
| Facility | | $1,400.00 | $1,400.00 | $1,400.00 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,141.00 / $4,717.00 / $11,696.00
| Facility | | $1,141.00 | $4,717.00 | $11,696.00 |