- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $623.00 / $2,303.00 / $7,602.00
| Facility | | $623.00 | $2,303.00 | $7,602.00 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,417.00 / $2,181.00 / $3,004.00
| Facility | | $1,417.00 | $2,181.00 | $3,004.00 |
- 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
- $2,941.75 / $3,014.15 / $16,394.00
| Facility | | $2,941.75 | $3,014.15 | $16,394.00 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $294.00 / $808.00 / $2,577.00
| Facility | | $294.00 | $808.00 | $2,577.00 |