- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $701.67 / $834.74 / $1,700.00
| Facility | | $701.67 | $834.74 | $1,700.00 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $780.95 / $780.95 / $947.24
| Facility | | $780.95 | $780.95 | $947.24 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,252.25 / $1,252.25 / $1,252.25
| Facility | | $1,252.25 | $1,252.25 | $1,252.25 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $19,451.75 / $19,451.75 / $20,125.63
| Facility | | $19,451.75 | $19,451.75 | $20,125.63 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $8,024.23 / $8,024.23 / $8,024.23
| Facility | | $8,024.23 | $8,024.23 | $8,024.23 |