- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,002.31 / $2,678.00 / $7,602.00
| Facility | | $1,002.31 | $2,678.00 | $7,602.00 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2,430.00 / $7,178.00 / $13,623.00
| Facility | | $2,430.00 | $7,178.00 | $13,623.00 |
- 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
- $3,465.00 / $26,542.00 / $48,160.90
| Facility | | $3,465.00 | $26,542.00 | $48,160.90 |
- 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 |