- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $548.27 / $2,303.00 / $7,602.00
| Facility | | $548.27 | $2,303.00 | $7,602.00 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,917.00 / $3,611.00 / $5,959.00
| Facility | | $1,917.00 | $3,611.00 | $5,959.00 |
- 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
- $1,397.92 / $1,524.89 / $16,394.00
| Facility | | $1,397.92 | $1,524.89 | $16,394.00 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,750.00 / $3,616.00 / $6,291.00
| Facility | | $1,750.00 | $3,616.00 | $6,291.00 |