- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,127.45 / $2,678.00 / $7,182.00
| Facility | | $1,127.45 | $2,678.00 | $7,182.00 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2,367.00 / $5,579.00 / $9,419.00
| Facility | | $2,367.00 | $5,579.00 | $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
- $2,766.45 / $19,913.50 / $26,542.00
| Facility | | $2,766.45 | $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 |