- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $352.99 / $2,258.00 / $6,681.00
| Facility | | $352.99 | $2,258.00 | $6,681.00 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2,467.00 / $9,265.00 / $16,534.00
| Facility | | $2,467.00 | $9,265.00 | $16,534.00 |
- 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
- $2,016.24 / $2,064.36 / $22,000.00
| Facility | | $2,016.24 | $2,064.36 | $22,000.00 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $6,827.00 / $16,000.00 / $36,683.00
| Facility | | $6,827.00 | $16,000.00 | $36,683.00 |