- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,402.07 / $1,402.07 / $1,402.07
| Facility | | $1,402.07 | $1,402.07 | $1,402.07 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2,671.56 / $5,743.86 / $11,353.88
| Facility | | $2,671.56 | $5,743.86 | $11,353.88 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $3,113.85 / $4,415.83 / $10,622.87
| Facility | | $3,113.85 | $4,415.83 | $10,622.87 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2,531.34 / $4,037.12 / $8,364.45
| Facility | | $2,531.34 | $4,037.12 | $8,364.45 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,901.67 / $2,759.27 / $9,793.00
| Facility | | $1,901.67 | $2,759.27 | $9,793.00 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $4,342.50 / $7,872.00 / $11,531.00
| Facility | | $4,342.50 | $7,872.00 | $11,531.00 |