- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $750.06 / $750.06 / $750.06
| Facility | | $750.06 | $750.06 | $750.06 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,173.08 / $2,992.74 / $6,483.73
| Facility | | $1,173.08 | $2,992.74 | $6,483.73 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,760.19 / $2,747.20 / $6,608.76
| Facility | | $1,760.19 | $2,747.20 | $6,608.76 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,525.36 / $2,507.00 / $5,203.75
| Facility | | $1,525.36 | $2,507.00 | $5,203.75 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $819.03 / $1,391.22 / $2,538.14
| Facility | | $819.03 | $1,391.22 | $2,538.14 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,623.00 / $4,746.00 / $8,812.00
| Facility | | $1,623.00 | $4,746.00 | $8,812.00 |