- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,230.00 / $2,800.00 / $7,602.00
| Facility | | $1,230.00 | $2,800.00 | $7,602.00 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $3,171.00 / $6,223.00 / $9,272.00
| Facility | | $3,171.00 | $6,223.00 | $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
- $3,723.76 / $25,239.65 / $26,542.00
| Facility | | $3,723.76 | $25,239.65 | $26,542.00 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $3,964.00 / $8,273.00 / $12,407.00
| Facility | | $3,964.00 | $8,273.00 | $12,407.00 |