- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $941.37 / $3,062.00 / $7,602.00
| Facility | | $941.37 | $3,062.00 | $7,602.00 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2,221.00 / $3,880.00 / $5,737.00
| Facility | | $2,221.00 | $3,880.00 | $5,737.00 |
- 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
- $3,165.80 / $8,957.00 / $26,542.00
| Facility | | $3,165.80 | $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 |