- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $677.07 / $2,520.00 / $6,681.00
| Facility | | $677.07 | $2,520.00 | $6,681.00 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2,132.00 / $3,728.00 / $5,959.00
| Facility | | $2,132.00 | $3,728.00 | $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
- $2,834.04 / $8,957.00 / $26,542.00
| Facility | | $2,834.04 | $8,957.00 | $26,542.00 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2,791.00 / $4,722.00 / $8,454.00
| Facility | | $2,791.00 | $4,722.00 | $8,454.00 |