- 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
- $3,691.00 / $7,194.00 / $13,498.00
| Facility | | $3,691.00 | $7,194.00 | $13,498.00 |
- 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
- $5,357.88 / $26,542.00 / $49,287.30
| Facility | | $5,357.88 | $26,542.00 | $49,287.30 |
- 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 |