- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $787.51 / $2,311.00 / $7,602.00
| Facility | | $787.51 | $2,311.00 | $7,602.00 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,917.00 / $3,549.00 / $5,774.00
| Facility | | $1,917.00 | $3,549.00 | $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
- $2,973.05 / $8,957.00 / $16,394.00
| Facility | | $2,973.05 | $8,957.00 | $16,394.00 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2,426.00 / $4,722.00 / $7,669.00
| Facility | | $2,426.00 | $4,722.00 | $7,669.00 |