- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $327.58 / $2,303.00 / $7,602.00
| Facility | | $327.58 | $2,303.00 | $7,602.00 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $764.00 / $1,522.00 / $2,330.00
| Facility | | $764.00 | $1,522.00 | $2,330.00 |
- 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
- $1,108.32 / $1,126.85 / $16,394.00
| Facility | | $1,108.32 | $1,126.85 | $16,394.00 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $695.00 / $1,560.00 / $2,914.00
| Facility | | $695.00 | $1,560.00 | $2,914.00 |