- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,124.27 / $2,678.00 / $7,602.00
| Facility | | $1,124.27 | $2,678.00 | $7,602.00 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,610.00 / $2,753.00 / $3,710.00
| Facility | | $1,610.00 | $2,753.00 | $3,710.00 |
- 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 / $15,924.26 / $16,275.38
| Facility | | $55.00 | $15,924.26 | $16,275.38 |
- 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 |