- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $900.36 / $2,678.00 / $7,602.00
| Facility | | $900.36 | $2,678.00 | $7,602.00 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2,430.00 / $7,133.00 / $13,498.00
| Facility | | $2,430.00 | $7,133.00 | $13,498.00 |
- 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
- $5,715.84 / $26,542.00 / $47,686.95
| Facility | | $5,715.84 | $26,542.00 | $47,686.95 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $3,964.00 / $8,273.00 / $12,407.00
| Facility | | $3,964.00 | $8,273.00 | $12,407.00 |