- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,733.44 / $2,678.00 / $7,602.00
| Facility | | $1,733.44 | $2,678.00 | $7,602.00 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,121.00 / $2,326.00 / $4,649.00
| Facility | | $1,121.00 | $2,326.00 | $4,649.00 |
- 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 / $8,033.12 / $8,257.84
| Facility | | $55.00 | $8,033.12 | $8,257.84 |
- 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 |