- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $850.78 / $2,303.00 / $7,602.00
| Facility | | $850.78 | $2,303.00 | $7,602.00 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,417.00 / $2,151.00 / $3,004.00
| Facility | | $1,417.00 | $2,151.00 | $3,004.00 |
- 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 / $5,488.45 / $5,585.10
| Facility | | $55.00 | $5,488.45 | $5,585.10 |
- 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 |