- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $874.02 / $874.02 / $874.02
| Facility | | $874.02 | $874.02 | $874.02 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,178.08 / $3,144.69 / $7,315.03
| Facility | | $1,178.08 | $3,144.69 | $7,315.03 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2,033.40 / $3,173.61 / $7,634.56
| Facility | | $2,033.40 | $3,173.61 | $7,634.56 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,762.12 / $2,896.13 / $6,011.46
| Facility | | $1,762.12 | $2,896.13 | $6,011.46 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $929.30 / $1,563.43 / $2,779.42
| Facility | | $929.30 | $1,563.43 | $2,779.42 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $796.00 / $3,500.00 / $8,152.00
| Facility | | $796.00 | $3,500.00 | $8,152.00 |