- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,375.00 / $1,375.00 / $1,375.00
| Facility | | $1,375.00 | $1,375.00 | $1,375.00 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2,670.24 / $5,741.02 / $11,425.39
| Facility | | $2,670.24 | $5,741.02 | $11,425.39 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $3,056.58 / $4,334.60 / $10,427.48
| Facility | | $3,056.58 | $4,334.60 | $10,427.48 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2,484.78 / $3,962.87 / $8,210.61
| Facility | | $2,484.78 | $3,962.87 | $8,210.61 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,981.27 / $2,504.21 / $3,727.20
| Facility | | $1,981.27 | $2,504.21 | $3,727.20 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,751.00 / $3,500.00 / $8,152.00
| Facility | | $1,751.00 | $3,500.00 | $8,152.00 |