- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $877.50 / $3,323.00 / $7,182.00
| Facility | | $877.50 | $3,323.00 | $7,182.00 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2,047.00 / $3,728.00 / $5,959.00
| Facility | | $2,047.00 | $3,728.00 | $5,959.00 |
- 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
- $1,736.04 / $8,957.00 / $26,542.00
| Facility | | $1,736.04 | $8,957.00 | $26,542.00 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $3,959.00 / $8,273.00 / $12,407.00
| Facility | | $3,959.00 | $8,273.00 | $12,407.00 |