- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $810.29 / $2,311.00 / $7,602.00
| Facility | | $810.29 | $2,311.00 | $7,602.00 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2,056.00 / $5,467.00 / $9,419.00
| Facility | | $2,056.00 | $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 / $17,132.00 / $17,132.00
| Facility | | $55.00 | $17,132.00 | $17,132.00 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $4,098.00 / $8,273.00 / $12,407.00
| Facility | | $4,098.00 | $8,273.00 | $12,407.00 |