- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $151.47 / $1,821.00 / $6,214.00
| Facility | | $151.47 | $1,821.00 | $6,214.00 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $108.00 / $148.00 / $2,367.00
| Facility | | $108.00 | $148.00 | $2,367.00 |
- 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
- $263.52 / $3,000.00 / $4,777.50
| Facility | | $263.52 | $3,000.00 | $4,777.50 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $294.00 / $808.00 / $2,577.00
| Facility | | $294.00 | $808.00 | $2,577.00 |