- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $772.08 / $3,940.00 / $10,746.00
| Facility | | $772.08 | $3,940.00 | $10,746.00 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2,303.00 / $4,109.00 / $6,480.00
| Facility | | $2,303.00 | $4,109.00 | $6,480.00 |
- 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
- $2,327.30 / $2,363.65 / $26,542.00
| Facility | | $2,327.30 | $2,363.65 | $26,542.00 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,794.00 / $3,616.00 / $6,291.00
| Facility | | $1,794.00 | $3,616.00 | $6,291.00 |