- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,656.00 / $3,939.75 / $7,403.00
| Facility | | $1,656.00 | $3,939.75 | $7,403.00 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,031.00 / $2,202.00 / $4,372.00
| Facility | | $1,031.00 | $2,202.00 | $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 / $8,803.28 / $8,984.64
| Facility | | $55.00 | $8,803.28 | $8,984.64 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $875.00 / $2,299.00 / $4,544.00
| Facility | | $875.00 | $2,299.00 | $4,544.00 |