- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $6,309.57 / $6,309.57 / $6,309.57
| Facility | | $6,309.57 | $6,309.57 | $6,309.57 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $5,623.41 / $9,120.11 / $14,791.08
| Facility | | $5,623.41 | $9,120.11 | $14,791.08 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $19,054.61 / $25,118.86 / $26,302.68
| Facility | | $19,054.61 | $25,118.86 | $26,302.68 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $6,309.57 / $6,309.57 / $15,488.17
| Facility | | $6,309.57 | $6,309.57 | $15,488.17 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $6,918.31 / $10,232.93 / $15,135.61
| Facility | | $6,918.31 | $10,232.93 | $15,135.61 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $7,413.10 / $10,232.93 / $25,118.86
| Facility | | $7,413.10 | $10,232.93 | $25,118.86 |