- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $943.15 / $1,473.76 / $7,362.00
| Facility | | $943.15 | $1,473.76 | $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
- $963.53 / $1,200.96 / $1,968.29
| Facility | | $963.53 | $1,200.96 | $1,968.29 |
- 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 / $5,634.65 / $5,634.65
| Facility | | $55.00 | $5,634.65 | $5,634.65 |