- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $606.00 / $2,311.00 / $7,602.00
| Facility | | $606.00 | $2,311.00 | $7,602.00 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2,056.00 / $5,467.00 / $9,272.00
| Facility | | $2,056.00 | $5,467.00 | $9,272.00 |
- 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
- $1,682.58 / $16,394.00 / $17,524.30
| Facility | | $1,682.58 | $16,394.00 | $17,524.30 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $3,964.00 / $8,273.00 / $12,407.00
| Facility | | $3,964.00 | $8,273.00 | $12,407.00 |