- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,346.00 / $3,610.59 / $4,995.00
| Facility | | $1,346.00 | $3,610.59 | $4,995.00 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,981.81 / $2,648.90 / $4,234.81
| Facility | | $1,981.81 | $2,648.90 | $4,234.81 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,874.72 / $3,207.18 / $5,237.35
| Facility | | $1,874.72 | $3,207.18 | $5,237.35 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,842.56 / $2,997.00 / $6,873.32
| Facility | | $1,842.56 | $2,997.00 | $6,873.32 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,698.30 / $2,909.09 / $4,233.76
| Facility | | $1,698.30 | $2,909.09 | $4,233.76 |