- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $3,086.77 / $3,086.77 / $3,086.77
| Facility | | $3,086.77 | $3,086.77 | $3,086.77 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2,579.54 / $6,665.78 / $25,150.24
| Facility | | $2,579.54 | $6,665.78 | $25,150.24 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $7,582.90 / $10,753.50 / $25,869.00
| Facility | | $7,582.90 | $10,753.50 | $25,869.00 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $6,164.35 / $9,831.28 / $20,369.29
| Facility | | $6,164.35 | $9,831.28 | $20,369.29 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $3,455.00 / $5,216.64 / $7,667.81
| Facility | | $3,455.00 | $5,216.64 | $7,667.81 |
- 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 |