- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2,311.00 / $3,795.78 / $7,602.00
| Facility | | $2,311.00 | $3,795.78 | $7,602.00 |
- 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 / $17,366.88 / $17,749.91
| Facility | | $55.00 | $17,366.88 | $17,749.91 |
- 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 |