- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $670.67 / $2,678.00 / $6,681.00
| Facility | | $670.67 | $2,678.00 | $6,681.00 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,662.00 / $2,867.00 / $4,235.00
| Facility | | $1,662.00 | $2,867.00 | $4,235.00 |
- 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
- $1,700.64 / $1,859.39 / $26,542.00
| Facility | | $1,700.64 | $1,859.39 | $26,542.00 |
- 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 |