- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $609.12 / $2,678.00 / $7,602.00
| Facility | | $609.12 | $2,678.00 | $7,602.00 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $110.00 / $150.00 / $2,052.00
| Facility | | $110.00 | $150.00 | $2,052.00 |
- 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
- $4,181.38 / $4,960.76 / $5,103.97
| Facility | | $4,181.38 | $4,960.76 | $5,103.97 |
- 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 |