- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,282.14 / $2,678.00 / $7,602.00
| Facility | | $1,282.14 | $2,678.00 | $7,602.00 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2,897.00 / $8,397.00 / $15,167.00
| Facility | | $2,897.00 | $8,397.00 | $15,167.00 |
- 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 / $4,562.28 / $4,636.80
| Facility | | $55.00 | $4,562.28 | $4,636.80 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $5,052.00 / $10,986.00 / $19,168.00
| Facility | | $5,052.00 | $10,986.00 | $19,168.00 |