- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $893.00 / $2,678.00 / $7,602.00
| Facility | | $893.00 | $2,678.00 | $7,602.00 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2,367.00 / $5,313.00 / $9,272.00
| Facility | | $2,367.00 | $5,313.00 | $9,272.00 |
- 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
- $2,292.92 / $19,913.50 / $26,542.00
| Facility | | $2,292.92 | $19,913.50 | $26,542.00 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2,064.00 / $3,728.00 / $7,371.00
| Facility | | $2,064.00 | $3,728.00 | $7,371.00 |