- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $622.04 / $975.22 / $7,362.00
| Facility | | $622.04 | $975.22 | $7,362.00 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $395.75 / $395.75 / $1,438.74
| Facility | | $395.75 | $395.75 | $1,438.74 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $622.04 / $794.00 / $1,239.83
| Facility | | $622.04 | $794.00 | $1,239.83 |
- 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
- $2,403.52 / $4,754.80 / $12,000.00
| Facility | | $2,403.52 | $4,754.80 | $12,000.00 |