- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,493.42 / $3,478.00 / $6,681.00
| Facility | | $1,493.42 | $3,478.00 | $6,681.00 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2,830.00 / $5,500.00 / $9,283.00
| Facility | | $2,830.00 | $5,500.00 | $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
- $7,930.14 / $8,175.54 / $26,542.00
| Facility | | $7,930.14 | $8,175.54 | $26,542.00 |
- 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 |