- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,656.00 / $3,939.75 / $7,602.00
| Facility | | $1,656.00 | $3,939.75 | $7,602.00 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $4,042.00 / $8,232.00 / $13,961.00
| Facility | | $4,042.00 | $8,232.00 | $13,961.00 |
- 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 / $20,541.62 / $21,063.90
| Facility | | $55.00 | $20,541.62 | $21,063.90 |
- 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 |