- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $390.44 / $2,089.00 / $6,681.00
| Facility | | $390.44 | $2,089.00 | $6,681.00 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2,128.00 / $3,688.00 / $5,774.00
| Facility | | $2,128.00 | $3,688.00 | $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
- $1,938.92 / $2,077.79 / $26,542.00
| Facility | | $1,938.92 | $2,077.79 | $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 |