- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $100.00 / $263.03 / $316.23
| Facility | | $100.00 | $263.03 | $316.23 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $14.13 / $32.36 / $398.11
| Facility | | $14.13 | $32.36 | $398.11 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $75.86 / $100.00 / $281.84
| Facility | | $75.86 | $100.00 | $281.84 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $100.00 / $100.00 / $100.00
| Facility | | $100.00 | $100.00 | $100.00 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $75.86 / $95.50 / $316.23
| Facility | | $75.86 | $95.50 | $316.23 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $75.86 / $89.13 / $204.17
| Facility | | $75.86 | $89.13 | $204.17 |