- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,270.24 / $1,270.24 / $1,270.24
| Facility | | $1,270.24 | $1,270.24 | $1,270.24 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2,659.07 / $5,932.79 / $11,628.58
| Facility | | $2,659.07 | $5,932.79 | $11,628.58 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $3,092.79 / $4,385.97 / $10,551.03
| Facility | | $3,092.79 | $4,385.97 | $10,551.03 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2,514.21 / $4,009.82 / $8,307.90
| Facility | | $2,514.21 | $4,009.82 | $8,307.90 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,802.82 / $2,213.90 / $3,500.00
| Facility | | $1,802.82 | $2,213.90 | $3,500.00 |
- 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 |