- 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
- $3,014.00 / $5,742.00 / $9,272.00
| Facility | | $3,014.00 | $5,742.00 | $9,272.00 |
- 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 / $15,674.10 / $16,084.38
| Facility | | $55.00 | $15,674.10 | $16,084.38 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2,905.00 / $6,073.00 / $10,287.00
| Facility | | $2,905.00 | $6,073.00 | $10,287.00 |