- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $767.22 / $2,303.00 / $7,602.00
| Facility | | $767.22 | $2,303.00 | $7,602.00 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,917.00 / $3,611.00 / $5,959.00
| Facility | | $1,917.00 | $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
- $2,240.96 / $8,957.00 / $16,394.00
| Facility | | $2,240.96 | $8,957.00 | $16,394.00 |
- 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 |