- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $782.16 / $2,303.00 / $7,602.00
| Facility | | $782.16 | $2,303.00 | $7,602.00 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,917.00 / $3,611.00 / $5,959.00
| Facility | | $1,917.00 | $3,611.00 | $5,959.00 |
- 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 / $3,056.48 / $3,056.48
| Facility | | $55.00 | $3,056.48 | $3,056.48 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2,370.17 / $4,567.00 / $7,669.00
| Facility | | $2,370.17 | $4,567.00 | $7,669.00 |