- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,021.20 / $3,323.00 / $7,182.00
| Facility | | $1,021.20 | $3,323.00 | $7,182.00 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2,132.00 / $3,611.00 / $5,878.00
| Facility | | $2,132.00 | $3,611.00 | $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
- $2,456.55 / $8,957.00 / $26,542.00
| Facility | | $2,456.55 | $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 |