- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $806.66 / $2,303.00 / $6,681.00
| Facility | | $806.66 | $2,303.00 | $6,681.00 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2,056.00 / $5,467.00 / $9,283.00
| Facility | | $2,056.00 | $5,467.00 | $9,283.00 |
- 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
- $2,383.92 / $16,394.00 / $19,913.50
| Facility | | $2,383.92 | $16,394.00 | $19,913.50 |
- 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 |