- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2,467.08 / $2,467.08 / $2,467.08
| Facility | | $2,467.08 | $2,467.08 | $2,467.08 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $4,723.37 / $10,155.25 / $20,304.83
| Facility | | $4,723.37 | $10,155.25 | $20,304.83 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $5,460.40 / $7,743.52 / $18,628.09
| Facility | | $5,460.40 | $7,743.52 | $18,628.09 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $4,438.91 / $7,079.44 / $14,667.79
| Facility | | $4,438.91 | $7,079.44 | $14,667.79 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2,990.68 / $3,906.16 / $6,244.86
| Facility | | $2,990.68 | $3,906.16 | $6,244.86 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,751.00 / $3,500.00 / $8,152.00
| Facility | | $1,751.00 | $3,500.00 | $8,152.00 |