- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2,124.41 / $3,940.00 / $7,602.00
| Facility | | $2,124.41 | $3,940.00 | $7,602.00 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $3,171.00 / $6,366.00 / $9,283.00
| Facility | | $3,171.00 | $6,366.00 | $9,283.00 |
- 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 / $30,466.15 / $31,126.70
| Facility | | $55.00 | $30,466.15 | $31,126.70 |
- 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 |