- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $591.16 / $2,303.00 / $6,681.00
| Facility | | $591.16 | $2,303.00 | $6,681.00 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,676.00 / $3,688.00 / $5,959.00
| Facility | | $1,676.00 | $3,688.00 | $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
- $4,446.33 / $8,957.00 / $12,000.00
| Facility | | $4,446.33 | $8,957.00 | $12,000.00 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,794.00 / $3,616.00 / $6,291.00
| Facility | | $1,794.00 | $3,616.00 | $6,291.00 |