- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2,203.15 / $2,678.00 / $7,602.00
| Facility | | $2,203.15 | $2,678.00 | $7,602.00 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,112.00 / $2,272.00 / $4,147.00
| Facility | | $1,112.00 | $2,272.00 | $4,147.00 |
- 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 / $10,077.20 / $10,320.32
| Facility | | $55.00 | $10,077.20 | $10,320.32 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,697.00 / $7,232.00 / $12,407.00
| Facility | | $1,697.00 | $7,232.00 | $12,407.00 |