- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,071.76 / $2,678.00 / $6,681.00
| Facility | | $1,071.76 | $2,678.00 | $6,681.00 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,375.00 / $2,267.00 / $3,441.00
| Facility | | $1,375.00 | $2,267.00 | $3,441.00 |
- 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
- $3,967.52 / $4,287.39 / $26,542.00
| Facility | | $3,967.52 | $4,287.39 | $26,542.00 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,695.00 / $3,616.00 / $6,291.00
| Facility | | $1,695.00 | $3,616.00 | $6,291.00 |