- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $614.66 / $614.66 / $614.66
| Facility | | $614.66 | $614.66 | $614.66 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $448.00 / $837.00 / $10,492.76
| Facility | | $448.00 | $837.00 | $10,492.76 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $257.89 / $415.00 / $2,221.46
| Facility | | $257.89 | $415.00 | $2,221.46 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $241.13 / $463.55 / $595.11
| Facility | | $241.13 | $463.55 | $595.11 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,224.00 / $12,269.00 / $18,722.00
| Facility | | $1,224.00 | $12,269.00 | $18,722.00 |