- 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 / $6,038.00 / $9,272.00
| Facility | | $3,013.00 | $6,038.00 | $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
- $2,000.00 / $16,547.20 / $16,547.20
| Facility | | $2,000.00 | $16,547.20 | $16,547.20 |
- 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 |