- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $622.67 / $2,311.00 / $7,602.00
| Facility | | $622.67 | $2,311.00 | $7,602.00 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2,467.00 / $8,463.00 / $15,167.00
| Facility | | $2,467.00 | $8,463.00 | $15,167.00 |
- 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
- $1,763.76 / $16,394.00 / $83,333.30
| Facility | | $1,763.76 | $16,394.00 | $83,333.30 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2,905.00 / $6,073.00 / $24,400.00
| Facility | | $2,905.00 | $6,073.00 | $24,400.00 |