- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $653.14 / $1,855.00 / $6,681.00
| Facility | | $653.14 | $1,855.00 | $6,681.00 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2,056.00 / $5,467.00 / $9,272.00
| Facility | | $2,056.00 | $5,467.00 | $9,272.00 |
- 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
- $1,826.80 / $16,394.00 / $26,526.55
| Facility | | $1,826.80 | $16,394.00 | $26,526.55 |
- 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 |