- 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
- $365.36 / $461.98 / $603.09
| Facility | | $365.36 | $461.98 | $603.09 |
- 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 / $2,250.00 / $2,936.00
| Facility | | $120.00 | $2,250.00 | $2,936.00 |