- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $676.25 / $2,311.00 / $7,602.00
| Facility | | $676.25 | $2,311.00 | $7,602.00 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,417.00 / $2,181.00 / $3,004.00
| Facility | | $1,417.00 | $2,181.00 | $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
- $1,331.84 / $4,017.35 / $16,394.00
| Facility | | $1,331.84 | $4,017.35 | $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 |