- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,315.30 / $1,315.30 / $1,315.30
| Facility | | $1,315.30 | $1,315.30 | $1,315.30 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $5,824.71 / $11,098.97 / $21,650.55
| Facility | | $5,824.71 | $11,098.97 | $21,650.55 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $3,061.20 / $4,777.74 / $11,493.50
| Facility | | $3,061.20 | $4,777.74 | $11,493.50 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2,652.80 / $4,360.00 / $9,050.00
| Facility | | $2,652.80 | $4,360.00 | $9,050.00 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,331.72 / $2,390.83 / $4,135.49
| Facility | | $1,331.72 | $2,390.83 | $4,135.49 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2,960.00 / $7,872.00 / $11,531.00
| Facility | | $2,960.00 | $7,872.00 | $11,531.00 |