- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $999.00 / $3,348.43 / $4,632.16
| Facility | | $999.00 | $3,348.43 | $4,632.16 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $428.40 / $1,144.16 / $3,000.00
| Facility | | $428.40 | $1,144.16 | $3,000.00 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,260.30 / $1,798.20 / $3,229.97
| Facility | | $1,260.30 | $1,798.20 | $3,229.97 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,260.30 / $1,741.36 / $3,229.97
| Facility | | $1,260.30 | $1,741.36 | $3,229.97 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $666.00 / $1,605.59 / $3,455.74
| Facility | | $666.00 | $1,605.59 | $3,455.74 |