- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $853.00 / $2,713.50 / $6,681.00
| Facility | | $853.00 | $2,713.50 | $6,681.00 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,662.00 / $2,870.00 / $4,235.00
| Facility | | $1,662.00 | $2,870.00 | $4,235.00 |
- 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
- $2,612.19 / $5,246.20 / $26,542.00
| Facility | | $2,612.19 | $5,246.20 | $26,542.00 |
- 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 |