- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $428.44 / $795.30 / $2,108.00
| Facility | | $428.44 | $795.30 | $2,108.00 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,833.00 / $2,146.00 / $3,929.00
| Facility | | $1,833.00 | $2,146.00 | $3,929.00 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $500.00 / $500.00 / $500.00
| Facility | | $500.00 | $500.00 | $500.00 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $100.00 / $120.00 / $345.40
| Facility | | $100.00 | $120.00 | $345.40 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $944.00 / $944.00 / $944.00
| Facility | | $944.00 | $944.00 | $944.00 |