- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $694.00 / $2,652.00 / $7,602.00
| Facility | | $694.00 | $2,652.00 | $7,602.00 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,671.00 / $2,867.00 / $3,728.00
| Facility | | $1,671.00 | $2,867.00 | $3,728.00 |
- 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
- $2,861.05 / $2,922.65 / $26,542.00
| Facility | | $2,861.05 | $2,922.65 | $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 |