- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $669.86 / $1,400.00 / $4,018.34
| Facility | | $669.86 | $1,400.00 | $4,018.34 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $710.50 / $802.92 / $874.79
| Facility | | $710.50 | $802.92 | $874.79 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $759.02 / $759.02 / $759.02
| Facility | | $759.02 | $759.02 | $759.02 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $5,672.06 / $5,672.06 / $5,672.06
| Facility | | $5,672.06 | $5,672.06 | $5,672.06 |
- 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 |