- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2,318.42 / $2,318.42 / $2,318.42
| Facility | | $2,318.42 | $2,318.42 | $2,318.42 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $4,873.17 / $6,604.40 / $12,398.15
| Facility | | $4,873.17 | $6,604.40 | $12,398.15 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2,318.42 / $3,941.33 / $7,856.00
| Facility | | $2,318.42 | $3,941.33 | $7,856.00 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $3,343.00 / $4,734.10 / $6,378.20
| Facility | | $3,343.00 | $4,734.10 | $6,378.20 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $3,054.00 / $4,317.00 / $13,909.00
| Facility | | $3,054.00 | $4,317.00 | $13,909.00 |