- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $270.52 / $2,667.00 / $6,681.00
| Facility | | $270.52 | $2,667.00 | $6,681.00 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2,132.00 / $3,728.00 / $5,959.00
| Facility | | $2,132.00 | $3,728.00 | $5,959.00 |
- 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
- $873.55 / $894.05 / $26,542.00
| Facility | | $873.55 | $894.05 | $26,542.00 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,130.00 / $2,297.00 / $4,099.00
| Facility | | $1,130.00 | $2,297.00 | $4,099.00 |