- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $399.26 / $399.26 / $2,168.00
| Facility | | $399.26 | $399.26 | $2,168.00 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,527.12 / $2,528.82 / $4,772.25
| Facility | | $1,527.12 | $2,528.82 | $4,772.25 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $939.02 / $1,465.57 / $3,525.63
| Facility | | $939.02 | $1,465.57 | $3,525.63 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $813.75 / $1,337.43 / $2,776.09
| Facility | | $813.75 | $1,337.43 | $2,776.09 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $399.26 / $719.55 / $1,307.17
| Facility | | $399.26 | $719.55 | $1,307.17 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,224.00 / $3,500.00 / $6,361.00
| Facility | | $1,224.00 | $3,500.00 | $6,361.00 |