- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,170.40 / $3,329.00 / $7,602.00
| Facility | | $1,170.40 | $3,329.00 | $7,602.00 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2,056.00 / $5,486.00 / $9,272.00
| Facility | | $2,056.00 | $5,486.00 | $9,272.00 |
- 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 / $4,917.43 / $5,020.82
| Facility | | $55.00 | $4,917.43 | $5,020.82 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $3,964.00 / $8,273.00 / $12,407.00
| Facility | | $3,964.00 | $8,273.00 | $12,407.00 |