- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $955.60 / $2,311.00 / $6,681.00
| Facility | | $955.60 | $2,311.00 | $6,681.00 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2,056.00 / $5,467.00 / $9,283.00
| Facility | | $2,056.00 | $5,467.00 | $9,283.00 |
- 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
- $3,482.35 / $16,394.00 / $25,119.35
| Facility | | $3,482.35 | $16,394.00 | $25,119.35 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2,905.00 / $6,073.00 / $10,287.00
| Facility | | $2,905.00 | $6,073.00 | $10,287.00 |