- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,302.70 / $1,579.42 / $1,820.98
| Facility | | $1,302.70 | $1,579.42 | $1,820.98 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,864.11 / $2,305.46 / $4,098.58
| Facility | | $1,864.11 | $2,305.46 | $4,098.58 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,252.00 / $2,554.00 / $3,843.00
| Facility | | $1,252.00 | $2,554.00 | $3,843.00 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,133.27 / $1,413.19 / $2,811.39
| Facility | | $1,133.27 | $1,413.19 | $2,811.39 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $300.00 / $787.00 / $2,794.80
| Facility | | $300.00 | $787.00 | $2,794.80 |