- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $782.17 / $2,678.00 / $7,602.00
| Facility | | $782.17 | $2,678.00 | $7,602.00 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2,047.00 / $3,753.00 / $5,959.00
| Facility | | $2,047.00 | $3,753.00 | $5,959.00 |
- 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
- $1,547.76 / $8,957.00 / $26,542.00
| Facility | | $1,547.76 | $8,957.00 | $26,542.00 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2,426.00 / $4,722.00 / $7,669.00
| Facility | | $2,426.00 | $4,722.00 | $7,669.00 |