- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2,851.66 / $2,851.66 / $2,851.66
| Facility | | $2,851.66 | $2,851.66 | $2,851.66 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $4,184.29 / $11,070.22 / $24,227.46
| Facility | | $4,184.29 | $11,070.22 | $24,227.46 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $7,034.59 / $9,975.92 / $23,998.43
| Facility | | $7,034.59 | $9,975.92 | $23,998.43 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $5,718.61 / $9,120.37 / $18,896.40
| Facility | | $5,718.61 | $9,120.37 | $18,896.40 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $3,455.00 / $4,819.31 / $7,537.19
| Facility | | $3,455.00 | $4,819.31 | $7,537.19 |
- 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 |