- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $401.92 / $3,940.00 / $10,746.00
| Facility | | $401.92 | $3,940.00 | $10,746.00 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2,364.00 / $4,109.00 / $6,581.00
| Facility | | $2,364.00 | $4,109.00 | $6,581.00 |
- 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
- $2,160.05 / $8,957.00 / $26,542.00
| Facility | | $2,160.05 | $8,957.00 | $26,542.00 |
- 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 |