- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $392.74 / $1,597.00 / $4,514.97
| Facility | | $392.74 | $1,597.00 | $4,514.97 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,081.25 / $1,947.29 / $3,580.62
| Facility | | $1,081.25 | $1,947.29 | $3,580.62 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $212.09 / $1,536.39 / $1,536.39
| Facility | | $212.09 | $1,536.39 | $1,536.39 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $275.27 / $650.00 / $1,197.32
| Facility | | $275.27 | $650.00 | $1,197.32 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $470.00 / $1,429.00 / $4,010.00
| Facility | | $470.00 | $1,429.00 | $4,010.00 |