- 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
- $2,830.00 / $5,486.00 / $9,419.00
| Facility | | $2,830.00 | $5,486.00 | $9,419.00 |
- 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
- $2,720.96 / $26,542.00 / $27,392.45
| Facility | | $2,720.96 | $26,542.00 | $27,392.45 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $3,372.00 / $6,090.00 / $12,183.00
| Facility | | $3,372.00 | $6,090.00 | $12,183.00 |