- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $617.83 / $2,678.00 / $7,602.00
| Facility | | $617.83 | $2,678.00 | $7,602.00 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $108.00 / $147.00 / $1,676.00
| Facility | | $108.00 | $147.00 | $1,676.00 |
- 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
- $698.86 / $1,510.80 / $5,000.00
| Facility | | $698.86 | $1,510.80 | $5,000.00 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,233.00 / $2,665.00 / $4,918.00
| Facility | | $1,233.00 | $2,665.00 | $4,918.00 |