- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $853.00 / $2,678.00 / $7,602.00
| Facility | | $853.00 | $2,678.00 | $7,602.00 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2,132.00 / $3,728.00 / $5,774.00
| Facility | | $2,132.00 | $3,728.00 | $5,774.00 |
- 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
- $55.00 / $3,187.68 / $3,187.68
| Facility | | $55.00 | $3,187.68 | $3,187.68 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2,370.17 / $4,567.00 / $10,545.00
| Facility | | $2,370.17 | $4,567.00 | $10,545.00 |