- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,150.00 / $2,940.00 / $7,602.00
| Facility | | $1,150.00 | $2,940.00 | $7,602.00 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2,358.88 / $4,002.00 / $5,878.00
| Facility | | $2,358.88 | $4,002.00 | $5,878.00 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $30.00 / $30.00 / $30.00
| Facility | | $30.00 | $30.00 | $30.00 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $3,508.56 / $8,957.00 / $26,542.00
| Facility | | $3,508.56 | $8,957.00 | $26,542.00 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2,905.00 / $6,073.00 / $10,287.00
| Facility | | $2,905.00 | $6,073.00 | $10,287.00 |