- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,256.00 / $2,940.00 / $7,602.00
| Facility | | $1,256.00 | $2,940.00 | $7,602.00 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2,056.00 / $5,434.00 / $9,419.00
| Facility | | $2,056.00 | $5,434.00 | $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 / $6,528.36 / $6,657.18
| Facility | | $55.00 | $6,528.36 | $6,657.18 |
- 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 |