- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $785.68 / $2,652.00 / $7,602.00
| Facility | | $785.68 | $2,652.00 | $7,602.00 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2,367.00 / $5,467.00 / $9,283.00
| Facility | | $2,367.00 | $5,467.00 | $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
- $3,348.40 / $3,623.11 / $26,542.00
| Facility | | $3,348.40 | $3,623.11 | $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 |