- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,084.25 / $2,940.00 / $7,602.00
| Facility | | $1,084.25 | $2,940.00 | $7,602.00 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2,358.00 / $3,927.00 / $5,737.00
| Facility | | $2,358.00 | $3,927.00 | $5,737.00 |
- 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
- $2,117.71 / $8,957.00 / $26,542.00
| Facility | | $2,117.71 | $8,957.00 | $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 |