- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,202.86 / $2,772.02 / $7,602.00
| Facility | | $1,202.86 | $2,772.02 | $7,602.00 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,417.00 / $2,272.00 / $3,777.00
| Facility | | $1,417.00 | $2,272.00 | $3,777.00 |
- 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
- $2,305.60 / $4,754.80 / $26,542.00
| Facility | | $2,305.60 | $4,754.80 | $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 |