- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2,537.19 / $3,940.00 / $7,602.00
| Facility | | $2,537.19 | $3,940.00 | $7,602.00 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,031.00 / $2,202.00 / $4,147.00
| Facility | | $1,031.00 | $2,202.00 | $4,147.00 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $500.00 / $525.00 / $2,530.00
| Facility | | $500.00 | $525.00 | $2,530.00 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $55.00 / $28,575.81 / $29,190.69
| Facility | | $55.00 | $28,575.81 | $29,190.69 |
- 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 |