- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $770.34 / $2,303.00 / $7,602.00
| Facility | | $770.34 | $2,303.00 | $7,602.00 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2,056.00 / $5,486.00 / $9,419.00
| Facility | | $2,056.00 | $5,486.00 | $9,419.00 |
- 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
- $3,129.64 / $3,302.06 / $16,394.00
| Facility | | $3,129.64 | $3,302.06 | $16,394.00 |
- 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 |