- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $3,710.67 / $3,710.67 / $3,710.67
| Facility | | $3,710.67 | $3,710.67 | $3,710.67 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $4,142.55 / $10,743.99 / $31,922.45
| Facility | | $4,142.55 | $10,743.99 | $31,922.45 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $9,147.83 / $12,972.76 / $31,207.73
| Facility | | $9,147.83 | $12,972.76 | $31,207.73 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $7,436.53 / $11,860.21 / $24,573.01
| Facility | | $7,436.53 | $11,860.21 | $24,573.01 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $3,500.00 / $6,271.03 / $10,085.71
| Facility | | $3,500.00 | $6,271.03 | $10,085.71 |
- 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 |