- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,268.02 / $4,088.45 / $7,540.00
| Facility | | $1,268.02 | $4,088.45 | $7,540.00 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2,056.00 / $5,486.00 / $9,272.00
| Facility | | $2,056.00 | $5,486.00 | $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
- $5,450.40 / $26,542.00 / $31,048.85
| Facility | | $5,450.40 | $26,542.00 | $31,048.85 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $5,052.00 / $10,986.00 / $19,007.00
| Facility | | $5,052.00 | $10,986.00 | $19,007.00 |