- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,539.90 / $2,678.00 / $7,602.00
| Facility | | $1,539.90 | $2,678.00 | $7,602.00 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $945.00 / $2,140.00 / $4,015.00
| Facility | | $945.00 | $2,140.00 | $4,015.00 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $500.00 / $525.00 / $2,277.00
| Facility | | $500.00 | $525.00 | $2,277.00 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $55.00 / $7,138.08 / $7,286.24
| Facility | | $55.00 | $7,138.08 | $7,286.24 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $875.00 / $2,397.00 / $4,544.00
| Facility | | $875.00 | $2,397.00 | $4,544.00 |