- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,089.21 / $3,940.00 / $7,970.87
| Facility | | $1,089.21 | $3,940.00 | $7,970.87 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2,201.00 / $3,880.00 / $5,737.00
| Facility | | $2,201.00 | $3,880.00 | $5,737.00 |
- 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 / $8,957.00 / $8,957.00
| Facility | | $2,000.00 | $8,957.00 | $8,957.00 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,130.00 / $2,297.00 / $4,099.00
| Facility | | $1,130.00 | $2,297.00 | $4,099.00 |