- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,198.80 / $1,698.30 / $2,906.89
| Facility | | $1,198.80 | $1,698.30 | $2,906.89 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,868.97 / $2,705.46 / $3,875.75
| Facility | | $1,868.97 | $2,705.46 | $3,875.75 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,544.67 / $2,350.05 / $3,439.76
| Facility | | $1,544.67 | $2,350.05 | $3,439.76 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,258.74 / $1,659.00 / $3,092.70
| Facility | | $1,258.74 | $1,659.00 | $3,092.70 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $300.00 / $883.00 / $3,460.14
| Facility | | $300.00 | $883.00 | $3,460.14 |