- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,256.00 / $3,329.00 / $7,602.00
| Facility | | $1,256.00 | $3,329.00 | $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 / $10,956.40 / $11,206.51
| Facility | | $55.00 | $10,956.40 | $11,206.51 |
- 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 |