- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $600.50 / $2,945.48 / $9,552.00
| Facility | | $600.50 | $2,945.48 | $9,552.00 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2,364.00 / $4,036.00 / $6,416.00
| Facility | | $2,364.00 | $4,036.00 | $6,416.00 |
- 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
- $1,806.96 / $8,957.00 / $26,542.00
| Facility | | $1,806.96 | $8,957.00 | $26,542.00 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,794.00 / $3,626.00 / $6,291.00
| Facility | | $1,794.00 | $3,626.00 | $6,291.00 |