- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $900.00 / $2,678.00 / $7,602.00
| Facility | | $900.00 | $2,678.00 | $7,602.00 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2,367.00 / $5,434.00 / $9,283.00
| Facility | | $2,367.00 | $5,434.00 | $9,283.00 |
- 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
- $3,494.15 / $19,913.50 / $26,542.00
| Facility | | $3,494.15 | $19,913.50 | $26,542.00 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2,426.00 / $4,722.00 / $7,669.00
| Facility | | $2,426.00 | $4,722.00 | $7,669.00 |