- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $631.66 / $1,722.16 / $6,681.00
| Facility | | $631.66 | $1,722.16 | $6,681.00 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,375.00 / $2,151.00 / $3,004.00
| Facility | | $1,375.00 | $2,151.00 | $3,004.00 |
- 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
- $2,349.76 / $2,552.32 / $16,394.00
| Facility | | $2,349.76 | $2,552.32 | $16,394.00 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,130.00 / $2,297.00 / $4,099.00
| Facility | | $1,130.00 | $2,297.00 | $4,099.00 |