- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $493.91 / $493.91 / $2,525.00
| Facility | | $493.91 | $493.91 | $2,525.00 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2,118.75 / $3,857.56 / $7,524.16
| Facility | | $2,118.75 | $3,857.56 | $7,524.16 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,233.28 / $1,749.85 / $4,209.49
| Facility | | $1,233.28 | $1,749.85 | $4,209.49 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,121.16 / $1,599.78 / $3,314.56
| Facility | | $1,121.16 | $1,599.78 | $3,314.56 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $523.28 / $880.06 / $2,735.00
| Facility | | $523.28 | $880.06 | $2,735.00 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2,412.00 / $4,746.00 / $8,812.00
| Facility | | $2,412.00 | $4,746.00 | $8,812.00 |