- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $773.17 / $2,655.40 / $6,681.00
| Facility | | $773.17 | $2,655.40 | $6,681.00 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2,367.00 / $5,486.00 / $9,283.00
| Facility | | $2,367.00 | $5,486.00 | $9,283.00 |
- 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
- $4,925.10 / $25,784.30 / $26,542.00
| Facility | | $4,925.10 | $25,784.30 | $26,542.00 |
- 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 |