- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,821.00 / $4,341.45 / $10,746.00
| Facility | | $1,821.00 | $4,341.45 | $10,746.00 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $3,391.00 / $9,284.00 / $16,534.00
| Facility | | $3,391.00 | $9,284.00 | $16,534.00 |
- 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 / $77,463.60 / $77,463.60
| Facility | | $55.00 | $77,463.60 | $77,463.60 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $5,052.00 / $10,848.00 / $19,168.00
| Facility | | $5,052.00 | $10,848.00 | $19,168.00 |