- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2,258.00 / $2,678.00 / $7,602.00
| Facility | | $2,258.00 | $2,678.00 | $7,602.00 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,031.00 / $2,218.00 / $4,232.00
| Facility | | $1,031.00 | $2,218.00 | $4,232.00 |
- 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 / $11,586.72 / $11,855.68
| Facility | | $55.00 | $11,586.72 | $11,855.68 |
- 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 |