- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $209.62 / $2,011.00 / $7,602.00
| Facility | | $209.62 | $2,011.00 | $7,602.00 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $764.00 / $1,504.00 / $2,257.00
| Facility | | $764.00 | $1,504.00 | $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 / $410.25 / $410.25
| Facility | | $55.00 | $410.25 | $410.25 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $719.00 / $1,560.00 / $2,914.00
| Facility | | $719.00 | $1,560.00 | $2,914.00 |