- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $783.24 / $2,311.00 / $6,681.00
| Facility | | $783.24 | $2,311.00 | $6,681.00 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,917.00 / $3,688.00 / $5,959.00
| Facility | | $1,917.00 | $3,688.00 | $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
- $2,087.92 / $2,277.25 / $26,542.00
| Facility | | $2,087.92 | $2,277.25 | $26,542.00 |
- 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 |