- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $629.80 / $2,311.00 / $6,681.00
| Facility | | $629.80 | $2,311.00 | $6,681.00 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2,047.00 / $3,753.00 / $6,090.00
| Facility | | $2,047.00 | $3,753.00 | $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
- $1,511.44 / $1,620.80 / $26,542.00
| Facility | | $1,511.44 | $1,620.80 | $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 |