- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $716.18 / $3,291.00 / $10,234.00
| Facility | | $716.18 | $3,291.00 | $10,234.00 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2,358.88 / $4,036.00 / $6,581.00
| Facility | | $2,358.88 | $4,036.00 | $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
- $2,345.80 / $2,528.94 / $26,542.00
| Facility | | $2,345.80 | $2,528.94 | $26,542.00 |
- 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 |