- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $776.90 / $2,678.00 / $7,602.00
| Facility | | $776.90 | $2,678.00 | $7,602.00 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,917.00 / $3,611.00 / $6,090.00
| Facility | | $1,917.00 | $3,611.00 | $6,090.00 |
- 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
- $1,500.08 / $8,957.00 / $26,542.00
| Facility | | $1,500.08 | $8,957.00 | $26,542.00 |
- 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 |