- 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
- $2,897.00 / $7,138.00 / $13,734.00
| Facility | | $2,897.00 | $7,138.00 | $13,734.00 |
- 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
- $2,302.76 / $26,542.00 / $48,287.50
| Facility | | $2,302.76 | $26,542.00 | $48,287.50 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $4,098.00 / $8,273.00 / $12,407.00
| Facility | | $4,098.00 | $8,273.00 | $12,407.00 |