- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,623.36 / $3,478.00 / $7,602.00
| Facility | | $1,623.36 | $3,478.00 | $7,602.00 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $3,171.00 / $6,848.00 / $12,048.00
| Facility | | $3,171.00 | $6,848.00 | $12,048.00 |
- 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
- $14,077.03 / $17,132.00 / $18,000.00
| Facility | | $14,077.03 | $17,132.00 | $18,000.00 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $4,098.00 / $8,273.00 / $12,407.00
| Facility | | $4,098.00 | $8,273.00 | $12,407.00 |