- 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
- $3,146.00 / $7,133.00 / $13,623.00
| Facility | | $3,146.00 | $7,133.00 | $13,623.00 |
- 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
- $2,556.84 / $26,542.00 / $57,467.65
| Facility | | $2,556.84 | $26,542.00 | $57,467.65 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $4,098.00 / $8,325.00 / $12,407.00
| Facility | | $4,098.00 | $8,325.00 | $12,407.00 |