- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $452.00 / $1,821.00 / $6,681.00
| Facility | | $452.00 | $1,821.00 | $6,681.00 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,275.00 / $2,136.00 / $2,805.00
| Facility | | $1,275.00 | $2,136.00 | $2,805.00 |
- 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
- $2,017.12 / $2,203.53 / $12,000.00
| Facility | | $2,017.12 | $2,203.53 | $12,000.00 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $294.00 / $808.00 / $2,577.00
| Facility | | $294.00 | $808.00 | $2,577.00 |