- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $580.04 / $2,678.00 / $7,602.00
| Facility | | $580.04 | $2,678.00 | $7,602.00 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2,221.00 / $4,002.00 / $5,878.00
| Facility | | $2,221.00 | $4,002.00 | $5,878.00 |
- 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
- $1,417.04 / $1,514.78 / $26,542.00
| Facility | | $1,417.04 | $1,514.78 | $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 |