- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,025.00 / $2,311.00 / $7,602.00
| Facility | | $1,025.00 | $2,311.00 | $7,602.00 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2,056.00 / $5,486.00 / $9,283.00
| Facility | | $2,056.00 | $5,486.00 | $9,283.00 |
- 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
- $5,952.78 / $16,394.00 / $18,039.43
| Facility | | $5,952.78 | $16,394.00 | $18,039.43 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2,905.00 / $6,073.00 / $10,287.00
| Facility | | $2,905.00 | $6,073.00 | $10,287.00 |