- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,100.00 / $2,678.00 / $7,602.00
| Facility | | $1,100.00 | $2,678.00 | $7,602.00 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2,686.00 / $5,486.00 / $9,419.00
| Facility | | $2,686.00 | $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
- $2,867.76 / $19,913.50 / $26,542.00
| Facility | | $2,867.76 | $19,913.50 | $26,542.00 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2,000.00 / $4,567.00 / $7,669.00
| Facility | | $2,000.00 | $4,567.00 | $7,669.00 |