- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $434.00 / $1,633.00 / $2,000.00
| Facility | | $434.00 | $1,633.00 | $2,000.00 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $188.35 / $188.35 / $188.35
| Facility | | $188.35 | $188.35 | $188.35 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $310.00 / $704.00 / $3,150.00
| Facility | | $310.00 | $704.00 | $3,150.00 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $450.00 / $944.00 / $2,282.00
| Facility | | $450.00 | $944.00 | $2,282.00 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $450.00 / $807.00 / $1,613.10
| Facility | | $450.00 | $807.00 | $1,613.10 |