- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $606.00 / $2,311.00 / $7,602.00
| Facility | | $606.00 | $2,311.00 | $7,602.00 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,375.00 / $2,271.00 / $3,470.00
| Facility | | $1,375.00 | $2,271.00 | $3,470.00 |
- 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 / $4,231.75 / $4,231.75
| Facility | | $55.00 | $4,231.75 | $4,231.75 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,128.00 / $2,260.00 / $4,099.00
| Facility | | $1,128.00 | $2,260.00 | $4,099.00 |