- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $900.00 / $2,678.00 / $7,602.00
| Facility | | $900.00 | $2,678.00 | $7,602.00 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2,367.00 / $5,467.00 / $9,419.00
| Facility | | $2,367.00 | $5,467.00 | $9,419.00 |
- 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 / $27,608.90 / $27,608.90
| Facility | | $55.00 | $27,608.90 | $27,608.90 |
- 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 |