- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2,109.84 / $2,678.00 / $7,602.00
| Facility | | $2,109.84 | $2,678.00 | $7,602.00 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,112.00 / $2,202.00 / $4,232.00
| Facility | | $1,112.00 | $2,202.00 | $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 / $9,708.40 / $9,925.76
| Facility | | $55.00 | $9,708.40 | $9,925.76 |
- 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 |