- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,821.00 / $2,683.00 / $7,602.00
| Facility | | $1,821.00 | $2,683.00 | $7,602.00 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $3,302.00 / $8,430.00 / $14,914.00
| Facility | | $3,302.00 | $8,430.00 | $14,914.00 |
- 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 / $15,705.47 / $16,144.81
| Facility | | $55.00 | $15,705.47 | $16,144.81 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $5,052.00 / $10,986.00 / $19,168.00
| Facility | | $5,052.00 | $10,986.00 | $19,168.00 |