- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,103.00 / $2,683.00 / $7,602.00
| Facility | | $1,103.00 | $2,683.00 | $7,602.00 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2,695.00 / $5,486.00 / $9,419.00
| Facility | | $2,695.00 | $5,486.00 | $9,419.00 |
- 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 / $10,965.92 / $11,233.36
| Facility | | $55.00 | $10,965.92 | $11,233.36 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2,905.00 / $6,073.00 / $10,287.00
| Facility | | $2,905.00 | $6,073.00 | $10,287.00 |