- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,103.00 / $2,946.05 / $7,602.00
| Facility | | $1,103.00 | $2,946.05 | $7,602.00 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2,897.00 / $7,194.00 / $13,961.00
| Facility | | $2,897.00 | $7,194.00 | $13,961.00 |
- 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
- $5,244.90 / $33,500.00 / $38,302.10
| Facility | | $5,244.90 | $33,500.00 | $38,302.10 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $4,098.00 / $8,273.00 / $12,407.00
| Facility | | $4,098.00 | $8,273.00 | $12,407.00 |