- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $571.47 / $917.46 / $7,362.00
| Facility | | $571.47 | $917.46 | $7,362.00 |
- 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
- $571.47 / $752.80 / $1,068.57
| Facility | | $571.47 | $752.80 | $1,068.57 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $117.00 / $896.00 / $2,229.00
| Facility | | $117.00 | $896.00 | $2,229.00 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $55.00 / $1,404.08 / $2,782.12
| Facility | | $55.00 | $1,404.08 | $2,782.12 |