- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $686.31 / $2,678.00 / $7,602.00
| Facility | | $686.31 | $2,678.00 | $7,602.00 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2,430.00 / $5,486.00 / $9,283.00
| Facility | | $2,430.00 | $5,486.00 | $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
- $1,627.28 / $1,771.80 / $26,542.00
| Facility | | $1,627.28 | $1,771.80 | $26,542.00 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2,064.00 / $3,728.00 / $7,371.00
| Facility | | $2,064.00 | $3,728.00 | $7,371.00 |