- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $512.01 / $2,678.00 / $6,681.00
| Facility | | $512.01 | $2,678.00 | $6,681.00 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2,439.00 / $5,500.00 / $9,283.00
| Facility | | $2,439.00 | $5,500.00 | $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
- $2,227.92 / $26,542.00 / $27,559.10
| Facility | | $2,227.92 | $26,542.00 | $27,559.10 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,794.00 / $3,626.00 / $6,291.00
| Facility | | $1,794.00 | $3,626.00 | $6,291.00 |