- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $297.00 / $1,300.00 / $3,779.00
| Facility | | $297.00 | $1,300.00 | $3,779.00 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2,151.98 / $10,074.86 / $14,151.63
| Facility | | $2,151.98 | $10,074.86 | $14,151.63 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $95.76 / $103.37 / $103.37
| Facility | | $95.76 | $103.37 | $103.37 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $400.00 / $400.00 / $400.00
| Facility | | $400.00 | $400.00 | $400.00 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $194.00 / $543.00 / $1,560.00
| Facility | | $194.00 | $543.00 | $1,560.00 |