- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,061.00 / $2,419.33 / $7,602.00
| Facility | | $1,061.00 | $2,419.33 | $7,602.00 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2,330.00 / $7,097.00 / $13,498.00
| Facility | | $2,330.00 | $7,097.00 | $13,498.00 |
- 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
- $5,321.75 / $16,394.00 / $48,920.50
| Facility | | $5,321.75 | $16,394.00 | $48,920.50 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2,426.00 / $4,722.00 / $7,669.00
| Facility | | $2,426.00 | $4,722.00 | $7,669.00 |