- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $626.42 / $2,311.00 / $7,602.00
| Facility | | $626.42 | $2,311.00 | $7,602.00 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,417.00 / $2,175.00 / $3,004.00
| Facility | | $1,417.00 | $2,175.00 | $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
- $1,231.35 / $4,754.80 / $16,394.00
| Facility | | $1,231.35 | $4,754.80 | $16,394.00 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,130.00 / $2,297.00 / $4,099.00
| Facility | | $1,130.00 | $2,297.00 | $4,099.00 |