- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $452.00 / $1,791.00 / $6,681.00
| Facility | | $452.00 | $1,791.00 | $6,681.00 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $764.00 / $1,480.00 / $2,244.00
| Facility | | $764.00 | $1,480.00 | $2,244.00 |
- 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 / $1,395.72 / $1,591.06
| Facility | | $55.00 | $1,395.72 | $1,591.06 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $277.00 / $794.00 / $2,577.00
| Facility | | $277.00 | $794.00 | $2,577.00 |