- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $533.12 / $2,133.00 / $7,602.00
| Facility | | $533.12 | $2,133.00 | $7,602.00 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,676.00 / $3,611.00 / $6,090.00
| Facility | | $1,676.00 | $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
- $1,013.16 / $8,957.00 / $12,000.00
| Facility | | $1,013.16 | $8,957.00 | $12,000.00 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,794.00 / $3,626.00 / $6,291.00
| Facility | | $1,794.00 | $3,626.00 | $6,291.00 |