- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2,258.00 / $3,276.92 / $7,602.00
| Facility | | $2,258.00 | $3,276.92 | $7,602.00 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,031.00 / $2,226.00 / $4,232.00
| Facility | | $1,031.00 | $2,226.00 | $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 / $15,024.32 / $15,384.88
| Facility | | $55.00 | $15,024.32 | $15,384.88 |
- 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 |