- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,327.01 / $4,069.00 / $10,746.00
| Facility | | $1,327.01 | $4,069.00 | $10,746.00 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2,358.88 / $4,109.00 / $6,581.00
| Facility | | $2,358.88 | $4,109.00 | $6,581.00 |
- 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
- $1,899.04 / $8,957.00 / $26,542.00
| Facility | | $1,899.04 | $8,957.00 | $26,542.00 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,130.00 / $2,297.00 / $4,099.00
| Facility | | $1,130.00 | $2,297.00 | $4,099.00 |