- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $656.07 / $2,254.00 / $7,602.00
| Facility | | $656.07 | $2,254.00 | $7,602.00 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2,367.00 / $5,486.00 / $9,419.00
| Facility | | $2,367.00 | $5,486.00 | $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 / $17,524.30 / $17,524.30
| Facility | | $55.00 | $17,524.30 | $17,524.30 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $3,964.00 / $8,273.00 / $12,407.00
| Facility | | $3,964.00 | $8,273.00 | $12,407.00 |