- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2,258.00 / $3,205.17 / $7,602.00
| Facility | | $2,258.00 | $3,205.17 | $7,602.00 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,112.00 / $2,267.00 / $4,372.00
| Facility | | $1,112.00 | $2,267.00 | $4,372.00 |
- 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 / $14,731.36 / $15,069.52
| Facility | | $55.00 | $14,731.36 | $15,069.52 |
- 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 |