- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $959.50 / $3,641.67 / $7,602.00
| Facility | | $959.50 | $3,641.67 | $7,602.00 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2,695.00 / $5,742.00 / $9,283.00
| Facility | | $2,695.00 | $5,742.00 | $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
- $2,102.60 / $25,682.95 / $26,542.00
| Facility | | $2,102.60 | $25,682.95 | $26,542.00 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $3,964.00 / $8,273.00 / $12,407.00
| Facility | | $3,964.00 | $8,273.00 | $12,407.00 |