- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,248.34 / $2,678.00 / $7,602.00
| Facility | | $1,248.34 | $2,678.00 | $7,602.00 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $3,276.00 / $6,672.00 / $11,975.00
| Facility | | $3,276.00 | $6,672.00 | $11,975.00 |
- 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 / $3,666.90 / $3,755.90
| Facility | | $55.00 | $3,666.90 | $3,755.90 |
- 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 |