- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,911.02 / $9,062.00 / $18,276.00
| Facility | | $1,911.02 | $9,062.00 | $18,276.00 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $4,367.20 / $9,254.95 / $15,459.94
| Facility | | $4,367.20 | $9,254.95 | $15,459.94 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2,594.85 / $2,594.85 / $2,594.85
| Facility | | $2,594.85 | $2,594.85 | $2,594.85 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,131.00 / $1,656.20 / $2,579.88
| Facility | | $1,131.00 | $1,656.20 | $2,579.88 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,779.00 / $12,456.00 / $19,591.00
| Facility | | $1,779.00 | $12,456.00 | $19,591.00 |