- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,056.68 / $2,897.40 / $7,318.79
| Facility | | $1,056.68 | $2,897.40 | $7,318.79 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2,128.00 / $3,753.00 / $6,090.00
| Facility | | $2,128.00 | $3,753.00 | $6,090.00 |
- 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
- $3,936.60 / $8,957.00 / $26,542.00
| Facility | | $3,936.60 | $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 |