- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,394.98 / $3,940.00 / $7,182.00
| Facility | | $1,394.98 | $3,940.00 | $7,182.00 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $3,013.00 / $5,998.00 / $9,272.00
| Facility | | $3,013.00 | $5,998.00 | $9,272.00 |
- 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
- $3,263.35 / $19,913.50 / $26,542.00
| Facility | | $3,263.35 | $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 |