- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,392.33 / $4,341.45 / $10,746.00
| Facility | | $1,392.33 | $4,341.45 | $10,746.00 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2,358.88 / $4,036.00 / $6,480.00
| Facility | | $2,358.88 | $4,036.00 | $6,480.00 |
- 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
- $3,968.04 / $7,909.30 / $26,542.00
| Facility | | $3,968.04 | $7,909.30 | $26,542.00 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2,120.00 / $3,599.00 / $7,035.00
| Facility | | $2,120.00 | $3,599.00 | $7,035.00 |