- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,256.00 / $3,069.46 / $7,602.00
| Facility | | $1,256.00 | $3,069.46 | $7,602.00 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2,358.00 / $4,002.00 / $5,878.00
| Facility | | $2,358.00 | $4,002.00 | $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 / $9,031.12 / $9,284.59
| Facility | | $55.00 | $9,031.12 | $9,284.59 |
- 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 |