- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $968.52 / $2,678.00 / $6,681.00
| Facility | | $968.52 | $2,678.00 | $6,681.00 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2,367.00 / $5,486.00 / $9,419.00
| Facility | | $2,367.00 | $5,486.00 | $9,419.00 |
- 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
- $6,301.38 / $6,565.62 / $26,542.00
| Facility | | $6,301.38 | $6,565.62 | $26,542.00 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2,905.00 / $6,073.00 / $10,287.00
| Facility | | $2,905.00 | $6,073.00 | $10,287.00 |