- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $297.00 / $1,273.00 / $3,500.00
| Facility | | $297.00 | $1,273.00 | $3,500.00 |
- 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
- $143.91 / $157.32 / $157.32
| Facility | | $143.91 | $157.32 | $157.32 |
- 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
- $882.00 / $3,474.00 / $9,160.00
| Facility | | $882.00 | $3,474.00 | $9,160.00 |