- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $283.00 / $283.00 / $283.00
| Facility | | $283.00 | $283.00 | $283.00 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $193.45 / $926.80 / $1,731.50
| Facility | | $193.45 | $926.80 | $1,731.50 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,888.35 / $4,133.00 / $7,129.23
| Facility | | $1,888.35 | $4,133.00 | $7,129.23 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $368.00 / $1,010.00 / $1,155.00
| Facility | | $368.00 | $1,010.00 | $1,155.00 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $100.00 / $200.00 / $20,000.00
| Facility | | $100.00 | $200.00 | $20,000.00 |