- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,368.94 / $2,977.65 / $7,602.00
| Facility | | $1,368.94 | $2,977.65 | $7,602.00 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2,367.00 / $5,579.00 / $9,283.00
| Facility | | $2,367.00 | $5,579.00 | $9,283.00 |
- 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 / $17,132.00 / $17,132.00
| Facility | | $2,000.00 | $17,132.00 | $17,132.00 |
- 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 |