- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $914.00 / $2,002.00 / $3,869.13
| Facility | | $914.00 | $2,002.00 | $3,869.13 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,059.15 / $1,796.86 / $3,401.27
| Facility | | $1,059.15 | $1,796.86 | $3,401.27 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,114.00 / $1,803.19 / $3,396.60
| Facility | | $1,114.00 | $1,803.19 | $3,396.60 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $902.00 / $1,440.00 / $2,875.62
| Facility | | $902.00 | $1,440.00 | $2,875.62 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $602.00 / $2,155.84 / $4,000.40
| Facility | | $602.00 | $2,155.84 | $4,000.40 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $585.00 / $1,668.93 / $3,240.56
| Facility | | $585.00 | $1,668.93 | $3,240.56 |