- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2,258.00 / $2,813.45 / $7,602.00
| Facility | | $2,258.00 | $2,813.45 | $7,602.00 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $945.00 / $2,271.00 / $4,147.00
| Facility | | $945.00 | $2,271.00 | $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 / $22,412.60 / $23,391.34
| Facility | | $55.00 | $22,412.60 | $23,391.34 |
- 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 |