- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2,193.17 / $2,678.00 / $7,602.00
| Facility | | $2,193.17 | $2,678.00 | $7,602.00 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,031.00 / $2,181.00 / $4,232.00
| Facility | | $1,031.00 | $2,181.00 | $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 / $10,004.32 / $10,317.04
| Facility | | $55.00 | $10,004.32 | $10,317.04 |
- 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 |