- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $515.71 / $515.71 / $2,525.00
| Facility | | $515.71 | $515.71 | $2,525.00 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2,088.76 / $4,376.30 / $9,046.11
| Facility | | $2,088.76 | $4,376.30 | $9,046.11 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,259.38 / $1,786.87 / $4,298.57
| Facility | | $1,259.38 | $1,786.87 | $4,298.57 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,144.89 / $1,633.63 / $3,384.70
| Facility | | $1,144.89 | $1,633.63 | $3,384.70 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $517.84 / $883.24 / $2,296.00
| Facility | | $517.84 | $883.24 | $2,296.00 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,388.00 / $3,500.00 / $6,361.00
| Facility | | $1,388.00 | $3,500.00 | $6,361.00 |