- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $739.10 / $2,303.00 / $7,602.00
| Facility | | $739.10 | $2,303.00 | $7,602.00 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,417.00 / $2,197.00 / $3,004.00
| Facility | | $1,417.00 | $2,197.00 | $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
- $1,461.48 / $4,754.80 / $16,394.00
| Facility | | $1,461.48 | $4,754.80 | $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 |