- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2,153.06 / $2,153.06 / $2,153.06
| Facility | | $2,153.06 | $2,153.06 | $2,153.06 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $4,478.89 / $9,629.61 / $18,983.20
| Facility | | $4,478.89 | $9,629.61 | $18,983.20 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $5,451.97 / $7,731.58 / $18,599.36
| Facility | | $5,451.97 | $7,731.58 | $18,599.36 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $4,432.06 / $7,068.52 / $14,645.16
| Facility | | $4,432.06 | $7,068.52 | $14,645.16 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2,871.53 / $3,833.39 / $6,052.17
| Facility | | $2,871.53 | $3,833.39 | $6,052.17 |
- 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 |