- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,280.04 / $3,478.00 / $7,602.00
| Facility | | $1,280.04 | $3,478.00 | $7,602.00 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2,695.00 / $5,467.00 / $9,272.00
| Facility | | $2,695.00 | $5,467.00 | $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 / $8,089.76 / $8,281.70
| Facility | | $55.00 | $8,089.76 | $8,281.70 |
- 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 |