- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $905.38 / $2,678.00 / $7,602.00
| Facility | | $905.38 | $2,678.00 | $7,602.00 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2,128.00 / $3,753.00 / $6,183.00
| Facility | | $2,128.00 | $3,753.00 | $6,183.00 |
- 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
- $5,703.42 / $6,936.48 / $26,542.00
| Facility | | $5,703.42 | $6,936.48 | $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 |