- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $454.00 / $3,048.00 / $6,680.31
| Facility | | $454.00 | $3,048.00 | $6,680.31 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $338.83 / $3,776.99 / $7,314.25
| Facility | | $338.83 | $3,776.99 | $7,314.25 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $863.00 / $2,171.83 / $4,735.26
| Facility | | $863.00 | $2,171.83 | $4,735.26 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,327.53 / $2,643.55 / $5,264.33
| Facility | | $1,327.53 | $2,643.55 | $5,264.33 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $750.00 / $1,460.00 / $4,781.41
| Facility | | $750.00 | $1,460.00 | $4,781.41 |