- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $395.00 / $1,246.00 / $4,823.00
| Facility | | $395.00 | $1,246.00 | $4,823.00 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $30.56 / $372.55 / $1,624.43
| Facility | | $30.56 | $372.55 | $1,624.43 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $390.20 / $1,080.00 / $3,895.00
| Facility | | $390.20 | $1,080.00 | $3,895.00 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,848.00 / $6,801.00 / $10,000.00
| Facility | | $1,848.00 | $6,801.00 | $10,000.00 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $481.00 / $819.00 / $3,328.00
| Facility | | $481.00 | $819.00 | $3,328.00 |