- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $657.86 / $2,258.00 / $7,602.00
| Facility | | $657.86 | $2,258.00 | $7,602.00 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,417.00 / $2,181.00 / $3,004.00
| Facility | | $1,417.00 | $2,181.00 | $3,004.00 |
- 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 / $4,179.20 / $4,248.60
| Facility | | $55.00 | $4,179.20 | $4,248.60 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,130.00 / $2,297.00 / $4,099.00
| Facility | | $1,130.00 | $2,297.00 | $4,099.00 |