- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $781.00 / $2,311.00 / $7,602.00
| Facility | | $781.00 | $2,311.00 | $7,602.00 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2,163.00 / $10,320.00 / $19,034.00
| Facility | | $2,163.00 | $10,320.00 | $19,034.00 |
- 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 / $152,237.35 / $152,237.35
| Facility | | $55.00 | $152,237.35 | $152,237.35 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $8,488.00 / $20,646.00 / $42,384.00
| Facility | | $8,488.00 | $20,646.00 | $42,384.00 |