- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,514.72 / $2,678.00 / $7,602.00
| Facility | | $1,514.72 | $2,678.00 | $7,602.00 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,031.00 / $2,226.00 / $4,015.00
| Facility | | $1,031.00 | $2,226.00 | $4,015.00 |
- 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 / $7,038.40 / $7,221.44
| Facility | | $55.00 | $7,038.40 | $7,221.44 |
- 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 |