- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,103.00 / $2,678.00 / $7,602.00
| Facility | | $1,103.00 | $2,678.00 | $7,602.00 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2,201.00 / $3,927.00 / $5,774.00
| Facility | | $2,201.00 | $3,927.00 | $5,774.00 |
- 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 / $7,548.10 / $7,703.71
| Facility | | $55.00 | $7,548.10 | $7,703.71 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2,426.00 / $4,722.00 / $7,669.00
| Facility | | $2,426.00 | $4,722.00 | $7,669.00 |