- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $198.53 / $2,303.00 / $6,681.00
| Facility | | $198.53 | $2,303.00 | $6,681.00 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,375.00 / $2,161.00 / $3,047.00
| Facility | | $1,375.00 | $2,161.00 | $3,047.00 |
- 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
- $542.04 / $550.40 / $16,394.00
| Facility | | $542.04 | $550.40 | $16,394.00 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,130.00 / $2,297.00 / $4,099.00
| Facility | | $1,130.00 | $2,297.00 | $4,099.00 |