- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,100.24 / $2,408.00 / $7,602.00
| Facility | | $1,100.24 | $2,408.00 | $7,602.00 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,417.00 / $2,302.00 / $4,582.00
| Facility | | $1,417.00 | $2,302.00 | $4,582.00 |
- 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 / $9,913.12 / $10,108.70
| Facility | | $55.00 | $9,913.12 | $10,108.70 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,128.00 / $2,260.00 / $4,099.00
| Facility | | $1,128.00 | $2,260.00 | $4,099.00 |