- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $890.51 / $2,311.00 / $7,602.00
| Facility | | $890.51 | $2,311.00 | $7,602.00 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2,052.00 / $5,434.00 / $9,283.00
| Facility | | $2,052.00 | $5,434.00 | $9,283.00 |
- 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 / $8,061.34 / $8,307.04
| Facility | | $55.00 | $8,061.34 | $8,307.04 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2,905.00 / $6,073.00 / $10,287.00
| Facility | | $2,905.00 | $6,073.00 | $10,287.00 |