- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $234.02 / $382.93 / $7,439.00
| Facility | | $234.02 | $382.93 | $7,439.00 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $606.10 / $606.10 / $606.10
| Facility | | $606.10 | $606.10 | $606.10 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $234.02 / $304.23 / $463.16
| Facility | | $234.02 | $304.23 | $463.16 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $900.00 / $3,733.00 / $6,543.00
| Facility | | $900.00 | $3,733.00 | $6,543.00 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $55.00 / $3,623.65 / $4,231.75
| Facility | | $55.00 | $3,623.65 | $4,231.75 |