- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,054.00 / $2,002.00 / $3,869.13
| Facility | | $1,054.00 | $2,002.00 | $3,869.13 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2,114.48 / $2,636.62 / $3,702.86
| Facility | | $2,114.48 | $2,636.62 | $3,702.86 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $980.76 / $1,542.33 / $2,552.46
| Facility | | $980.76 | $1,542.33 | $2,552.46 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $952.00 / $1,152.00 / $2,297.69
| Facility | | $952.00 | $1,152.00 | $2,297.69 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $772.00 / $1,640.56 / $4,352.24
| Facility | | $772.00 | $1,640.56 | $4,352.24 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $772.00 / $1,625.77 / $3,451.15
| Facility | | $772.00 | $1,625.77 | $3,451.15 |