- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $589.71 / $2,133.00 / $7,602.00
| Facility | | $589.71 | $2,133.00 | $7,602.00 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,676.00 / $3,611.00 / $5,959.00
| Facility | | $1,676.00 | $3,611.00 | $5,959.00 |
- 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
- $2,443.67 / $8,957.00 / $12,000.00
| Facility | | $2,443.67 | $8,957.00 | $12,000.00 |
- 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 |