- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $582.00 / $2,303.00 / $7,602.00
| Facility | | $582.00 | $2,303.00 | $7,602.00 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2,430.00 / $7,266.00 / $13,734.00
| Facility | | $2,430.00 | $7,266.00 | $13,734.00 |
- 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 / $2,061.94 / $6,087.98
| Facility | | $55.00 | $2,061.94 | $6,087.98 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2,905.00 / $6,073.00 / $10,287.00
| Facility | | $2,905.00 | $6,073.00 | $10,287.00 |