- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $243.13 / $381.68 / $14,516.00
| Facility | | $243.13 | $381.68 | $14,516.00 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $606.10 / $606.10 / $28,053.00
| Facility | | $606.10 | $606.10 | $28,053.00 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $243.13 / $291.76 / $456.44
| Facility | | $243.13 | $291.76 | $456.44 |
- 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 / $922.72 / $1,173.82
| Facility | | $55.00 | $922.72 | $1,173.82 |