- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $606.00 / $2,303.00 / $7,602.00
| Facility | | $606.00 | $2,303.00 | $7,602.00 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,917.00 / $3,500.00 / $5,774.00
| Facility | | $1,917.00 | $3,500.00 | $5,774.00 |
- 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
- $1,732.32 / $1,855.30 / $16,394.00
| Facility | | $1,732.32 | $1,855.30 | $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 |