- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,185.71 / $2,678.00 / $7,602.00
| Facility | | $1,185.71 | $2,678.00 | $7,602.00 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2,174.00 / $3,688.00 / $5,878.00
| Facility | | $2,174.00 | $3,688.00 | $5,878.00 |
- 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 / $10,636.64 / $10,885.91
| Facility | | $55.00 | $10,636.64 | $10,885.91 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,794.00 / $3,626.00 / $6,291.00
| Facility | | $1,794.00 | $3,626.00 | $6,291.00 |