- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $915.64 / $2,678.00 / $7,602.00
| Facility | | $915.64 | $2,678.00 | $7,602.00 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2,897.00 / $7,266.00 / $13,623.00
| Facility | | $2,897.00 | $7,266.00 | $13,623.00 |
- 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
- $4,189.26 / $26,542.00 / $47,686.95
| Facility | | $4,189.26 | $26,542.00 | $47,686.95 |
- 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 |