- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $865.00 / $2,027.25 / $6,681.00
| Facility | | $865.00 | $2,027.25 | $6,681.00 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,917.00 / $3,688.00 / $6,090.00
| Facility | | $1,917.00 | $3,688.00 | $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
- $3,869.30 / $8,957.00 / $16,394.00
| Facility | | $3,869.30 | $8,957.00 | $16,394.00 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2,370.17 / $4,567.00 / $7,669.00
| Facility | | $2,370.17 | $4,567.00 | $7,669.00 |