- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,638.23 / $2,678.00 / $7,602.00
| Facility | | $1,638.23 | $2,678.00 | $7,602.00 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $3,014.00 / $6,563.00 / $10,237.00
| Facility | | $3,014.00 | $6,563.00 | $10,237.00 |
- 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 / $4,666.75 / $4,860.64
| Facility | | $55.00 | $4,666.75 | $4,860.64 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $4,186.00 / $8,222.00 / $13,200.00
| Facility | | $4,186.00 | $8,222.00 | $13,200.00 |