- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,307.54 / $2,893.34 / $9,967.68
| Facility | | $1,307.54 | $2,893.34 | $9,967.68 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2,430.00 / $5,467.00 / $9,419.00
| Facility | | $2,430.00 | $5,467.00 | $9,419.00 |
- 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
- $5,801.10 / $19,913.50 / $26,542.00
| Facility | | $5,801.10 | $19,913.50 | $26,542.00 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $3,959.00 / $8,273.00 / $12,407.00
| Facility | | $3,959.00 | $8,273.00 | $12,407.00 |