- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $857.10 / $2,678.00 / $7,602.00
| Facility | | $857.10 | $2,678.00 | $7,602.00 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,375.00 / $2,267.00 / $3,470.00
| Facility | | $1,375.00 | $2,267.00 | $3,470.00 |
- 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
- $1,676.56 / $4,754.80 / $26,542.00
| Facility | | $1,676.56 | $4,754.80 | $26,542.00 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,130.00 / $2,297.00 / $4,099.00
| Facility | | $1,130.00 | $2,297.00 | $4,099.00 |