- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,600.61 / $3,105.00 / $7,602.00
| Facility | | $1,600.61 | $3,105.00 | $7,602.00 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2,132.00 / $3,728.00 / $5,737.00
| Facility | | $2,132.00 | $3,728.00 | $5,737.00 |
- 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 / $22,662.20 / $23,095.49
| Facility | | $55.00 | $22,662.20 | $23,095.49 |
- 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 |