- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $582.00 / $2,258.00 / $7,602.00
| Facility | | $582.00 | $2,258.00 | $7,602.00 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2,037.00 / $7,178.00 / $13,623.00
| Facility | | $2,037.00 | $7,178.00 | $13,623.00 |
- 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
- $1,461.85 / $12,000.00 / $77,786.45
| Facility | | $1,461.85 | $12,000.00 | $77,786.45 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $5,052.00 / $10,986.00 / $34,104.00
| Facility | | $5,052.00 | $10,986.00 | $34,104.00 |