- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $309.03 / $309.03 / $309.03
| Facility | | $309.03 | $309.03 | $309.03 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $223.87 / $758.58 / $1,698.24
| Facility | | $223.87 | $758.58 | $1,698.24 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $724.44 / $1,023.29 / $2,454.71
| Facility | | $724.44 | $1,023.29 | $2,454.71 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $794.33 / $1,000.00 / $1,949.84
| Facility | | $794.33 | $1,000.00 | $1,949.84 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $436.52 / $575.44 / $2,398.83
| Facility | | $436.52 | $575.44 | $2,398.83 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,584.89 / $2,951.21 / $7,079.46
| Facility | | $1,584.89 | $2,951.21 | $7,079.46 |