- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $752.38 / $2,938.00 / $7,182.00
| Facility | | $752.38 | $2,938.00 | $7,182.00 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2,132.00 / $3,688.00 / $5,774.00
| Facility | | $2,132.00 | $3,688.00 | $5,774.00 |
- 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
- $3,315.00 / $8,957.00 / $26,542.00
| Facility | | $3,315.00 | $8,957.00 | $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 |