- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,500.00 / $4,069.00 / $10,746.00
| Facility | | $1,500.00 | $4,069.00 | $10,746.00 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $3,013.00 / $6,138.00 / $9,419.00
| Facility | | $3,013.00 | $6,138.00 | $9,419.00 |
- 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
- $5,552.58 / $23,438.60 / $26,542.00
| Facility | | $5,552.58 | $23,438.60 | $26,542.00 |
- 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 |