- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $725.94 / $2,293.00 / $6,681.00
| Facility | | $725.94 | $2,293.00 | $6,681.00 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,917.00 / $3,611.00 / $5,774.00
| Facility | | $1,917.00 | $3,611.00 | $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
- $4,336.92 / $4,411.74 / $16,394.00
| Facility | | $4,336.92 | $4,411.74 | $16,394.00 |
- 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 |