- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $348.60 / $348.60 / $1,600.00
| Facility | | $348.60 | $348.60 | $1,600.00 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $356.31 / $400.87 / $436.75
| Facility | | $356.31 | $400.87 | $436.75 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $382.07 / $382.07 / $382.07
| Facility | | $382.07 | $382.07 | $382.07 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $7,409.81 / $7,409.81 / $7,409.81
| Facility | | $7,409.81 | $7,409.81 | $7,409.81 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $5,128.56 / $5,128.56 / $5,128.56
| Facility | | $5,128.56 | $5,128.56 | $5,128.56 |