- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $750.00 / $2,303.00 / $7,602.00
| Facility | | $750.00 | $2,303.00 | $7,602.00 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2,309.00 / $5,486.00 / $9,272.00
| Facility | | $2,309.00 | $5,486.00 | $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
- $2,050.52 / $16,394.00 / $25,586.75
| Facility | | $2,050.52 | $16,394.00 | $25,586.75 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2,426.00 / $4,750.00 / $7,669.00
| Facility | | $2,426.00 | $4,750.00 | $7,669.00 |