- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,359.36 / $2,678.00 / $6,681.00
| Facility | | $1,359.36 | $2,678.00 | $6,681.00 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,531.00 / $3,323.00 / $5,737.00
| Facility | | $1,531.00 | $3,323.00 | $5,737.00 |
- 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 / $9,081.92 / $9,313.36
| Facility | | $55.00 | $9,081.92 | $9,313.36 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2,016.00 / $4,439.00 / $8,120.00
| Facility | | $2,016.00 | $4,439.00 | $8,120.00 |