- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,368.54 / $2,267.92 / $2,862.53
| Facility | | $1,368.54 | $2,267.92 | $2,862.53 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $480.00 / $2,052.94 / $2,088.51
| Facility | | $480.00 | $2,052.94 | $2,088.51 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $150.00 / $150.00 / $150.00
| Facility | | $150.00 | $150.00 | $150.00 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,046.00 / $2,320.67 / $3,715.68
| Facility | | $1,046.00 | $2,320.67 | $3,715.68 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,005.00 / $2,416.38 / $3,823.00
| Facility | | $1,005.00 | $2,416.38 | $3,823.00 |