- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $872.15 / $2,678.00 / $7,602.00
| Facility | | $872.15 | $2,678.00 | $7,602.00 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,417.00 / $2,272.00 / $3,441.00
| Facility | | $1,417.00 | $2,272.00 | $3,441.00 |
- 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
- $2,527.23 / $4,754.80 / $26,542.00
| Facility | | $2,527.23 | $4,754.80 | $26,542.00 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,128.00 / $2,260.00 / $4,099.00
| Facility | | $1,128.00 | $2,260.00 | $4,099.00 |