- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $893.00 / $2,678.00 / $7,602.00
| Facility | | $893.00 | $2,678.00 | $7,602.00 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,662.00 / $2,867.00 / $3,834.00
| Facility | | $1,662.00 | $2,867.00 | $3,834.00 |
- 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
- $1,719.52 / $5,246.20 / $26,542.00
| Facility | | $1,719.52 | $5,246.20 | $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 |