- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,256.00 / $2,794.39 / $7,602.00
| Facility | | $1,256.00 | $2,794.39 | $7,602.00 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2,695.00 / $5,467.00 / $9,272.00
| Facility | | $2,695.00 | $5,467.00 | $9,272.00 |
- 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
- $3,353.00 / $26,227.55 / $26,542.00
| Facility | | $3,353.00 | $26,227.55 | $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 |