- 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
- $3,287.00 / $9,558.00 / $16,629.00
| Facility | | $3,287.00 | $9,558.00 | $16,629.00 |
- 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
- $4,537.08 / $26,542.00 / $79,943.20
| Facility | | $4,537.08 | $26,542.00 | $79,943.20 |
- 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 |