- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $280.00 / $1,233.00 / $2,940.06
| Facility | | $280.00 | $1,233.00 | $2,940.06 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $913.82 / $1,401.71 / $4,672.99
| Facility | | $913.82 | $1,401.71 | $4,672.99 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $802.00 / $1,650.00 / $3,337.46
| Facility | | $802.00 | $1,650.00 | $3,337.46 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,166.59 / $2,241.76 / $3,843.15
| Facility | | $1,166.59 | $2,241.76 | $3,843.15 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $750.00 / $2,552.84 / $4,160.43
| Facility | | $750.00 | $2,552.84 | $4,160.43 |