- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,577.00 / $1,577.00 / $1,577.00
| Facility | | $1,577.00 | $1,577.00 | $1,577.00 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $317.48 / $464.07 / $1,123.28
| Facility | | $317.48 | $464.07 | $1,123.28 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,860.00 / $2,146.00 / $3,929.00
| Facility | | $1,860.00 | $2,146.00 | $3,929.00 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $565.00 / $1,104.00 / $2,210.00
| Facility | | $565.00 | $1,104.00 | $2,210.00 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $120.00 / $1,803.00 / $2,936.00
| Facility | | $120.00 | $1,803.00 | $2,936.00 |