- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,103.00 / $2,683.00 / $7,602.00
| Facility | | $1,103.00 | $2,683.00 | $7,602.00 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2,358.88 / $4,036.00 / $6,581.00
| Facility | | $2,358.88 | $4,036.00 | $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
- $4,868.35 / $6,817.20 / $26,542.00
| Facility | | $4,868.35 | $6,817.20 | $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 |