- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,350.95 / $2,678.00 / $7,602.00
| Facility | | $1,350.95 | $2,678.00 | $7,602.00 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2,897.00 / $7,266.00 / $13,734.00
| Facility | | $2,897.00 | $7,266.00 | $13,734.00 |
- 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 / $4,715.76 / $4,806.00
| Facility | | $55.00 | $4,715.76 | $4,806.00 |
- 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 |