- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2,012.55 / $2,012.55 / $2,012.55
| Facility | | $2,012.55 | $2,012.55 | $2,012.55 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $7,466.88 / $12,868.92 / $23,333.99
| Facility | | $7,466.88 | $12,868.92 | $23,333.99 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $4,688.22 / $7,317.11 / $17,602.30
| Facility | | $4,688.22 | $7,317.11 | $17,602.30 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $4,062.76 / $6,677.34 / $13,860.08
| Facility | | $4,062.76 | $6,677.34 | $13,860.08 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2,011.55 / $3,401.21 / $6,254.46
| Facility | | $2,011.55 | $3,401.21 | $6,254.46 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $796.00 / $2,260.00 / $5,379.86
| Facility | | $796.00 | $2,260.00 | $5,379.86 |