- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,241.31 / $2,700.05 / $7,602.00
| Facility | | $1,241.31 | $2,700.05 | $7,602.00 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2,695.00 / $5,467.00 / $9,283.00
| Facility | | $2,695.00 | $5,467.00 | $9,283.00 |
- 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
- $5,189.43 / $5,571.28 / $26,542.00
| Facility | | $5,189.43 | $5,571.28 | $26,542.00 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,794.00 / $3,626.00 / $6,291.00
| Facility | | $1,794.00 | $3,626.00 | $6,291.00 |