- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $588.84 / $1,000.00 / $1,000.00
| Facility | | $588.84 | $1,000.00 | $1,000.00 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $85.11 / $91.20 / $100.00
| Facility | | $85.11 | $91.20 | $100.00 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $588.84 / $707.95 / $1,348.96
| Facility | | $588.84 | $707.95 | $1,348.96 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $537.03 / $537.03 / $537.03
| Facility | | $537.03 | $537.03 | $537.03 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $117.49 / $194.98 / $316.23
| Facility | | $117.49 | $194.98 | $316.23 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $549.54 / $676.08 / $1,318.26
| Facility | | $549.54 | $676.08 | $1,318.26 |