- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $750.00 / $2,311.00 / $7,602.00
| Facility | | $750.00 | $2,311.00 | $7,602.00 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,576.00 / $2,859.00 / $3,710.00
| Facility | | $1,576.00 | $2,859.00 | $3,710.00 |
- 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
- $2,724.72 / $5,246.20 / $16,394.00
| Facility | | $2,724.72 | $5,246.20 | $16,394.00 |
- 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 |