- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,178.96 / $2,683.00 / $7,388.41
| Facility | | $1,178.96 | $2,683.00 | $7,388.41 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2,132.00 / $3,766.00 / $5,878.00
| Facility | | $2,132.00 | $3,766.00 | $5,878.00 |
- 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
- $2,266.67 / $8,957.00 / $26,542.00
| Facility | | $2,266.67 | $8,957.00 | $26,542.00 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2,370.17 / $4,567.00 / $7,669.00
| Facility | | $2,370.17 | $4,567.00 | $7,669.00 |