- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $814.02 / $2,655.40 / $6,681.00
| Facility | | $814.02 | $2,655.40 | $6,681.00 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2,662.00 / $7,178.00 / $13,734.00
| Facility | | $2,662.00 | $7,178.00 | $13,734.00 |
- 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
- $5,245.68 / $26,542.00 / $47,940.15
| Facility | | $5,245.68 | $26,542.00 | $47,940.15 |
- 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 |