- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $867.26 / $2,303.00 / $7,602.00
| Facility | | $867.26 | $2,303.00 | $7,602.00 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $764.00 / $1,500.00 / $2,257.00
| Facility | | $764.00 | $1,500.00 | $2,257.00 |
- 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 / $5,634.65 / $5,744.60
| Facility | | $55.00 | $5,634.65 | $5,744.60 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $294.00 / $808.00 / $2,577.00
| Facility | | $294.00 | $808.00 | $2,577.00 |