- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,198.92 / $1,198.92 / $1,198.92
| Facility | | $1,198.92 | $1,198.92 | $1,198.92 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2,509.28 / $6,122.28 / $11,054.66
| Facility | | $2,509.28 | $6,122.28 | $11,054.66 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2,955.50 / $4,191.27 / $10,082.67
| Facility | | $2,955.50 | $4,191.27 | $10,082.67 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2,402.61 / $3,831.83 / $7,939.11
| Facility | | $2,402.61 | $3,831.83 | $7,939.11 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,561.68 / $2,120.60 / $3,500.00
| Facility | | $1,561.68 | $2,120.60 | $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 |