- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,170.58 / $2,683.00 / $11,891.19
| Facility | | $1,170.58 | $2,683.00 | $11,891.19 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2,367.00 / $5,500.00 / $9,283.00
| Facility | | $2,367.00 | $5,500.00 | $9,283.00 |
- 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
- $2,281.67 / $19,913.50 / $26,542.00
| Facility | | $2,281.67 | $19,913.50 | $26,542.00 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $3,964.00 / $8,273.00 / $12,407.00
| Facility | | $3,964.00 | $8,273.00 | $12,407.00 |