- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $582.00 / $2,303.00 / $7,602.00
| Facility | | $582.00 | $2,303.00 | $7,602.00 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $110.00 / $150.00 / $1,676.00
| Facility | | $110.00 | $150.00 | $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
- $736.08 / $2,666.00 / $12,000.00
| Facility | | $736.08 | $2,666.00 | $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 |