- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2,311.00 / $3,940.00 / $7,602.00
| Facility | | $2,311.00 | $3,940.00 | $7,602.00 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,012.80 / $2,267.00 / $3,815.00
| Facility | | $1,012.80 | $2,267.00 | $3,815.00 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $500.00 / $525.00 / $2,530.00
| Facility | | $500.00 | $525.00 | $2,530.00 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $55.00 / $20,424.32 / $20,877.52
| Facility | | $55.00 | $20,424.32 | $20,877.52 |
- 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 |