- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,161.68 / $2,678.00 / $7,602.00
| Facility | | $1,161.68 | $2,678.00 | $7,602.00 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $756.00 / $1,487.00 / $2,244.00
| Facility | | $756.00 | $1,487.00 | $2,244.00 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $30.00 / $30.00 / $30.00
| Facility | | $30.00 | $30.00 | $30.00 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $55.00 / $4,069.92 / $4,166.16
| Facility | | $55.00 | $4,069.92 | $4,166.16 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $267.00 / $794.00 / $2,495.00
| Facility | | $267.00 | $794.00 | $2,495.00 |