- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,104.69 / $2,157.84 / $3,289.51
| Facility | | $1,104.69 | $2,157.84 | $3,289.51 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,413.27 / $3,635.61 / $4,193.93
| Facility | | $1,413.27 | $3,635.61 | $4,193.93 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,368.55 / $2,064.19 / $3,251.46
| Facility | | $1,368.55 | $2,064.19 | $3,251.46 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,318.68 / $2,089.91 / $3,718.28
| Facility | | $1,318.68 | $2,089.91 | $3,718.28 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $558.00 / $1,640.36 / $3,687.11
| Facility | | $558.00 | $1,640.36 | $3,687.11 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $350.00 / $1,184.10 / $3,687.11
| Facility | | $350.00 | $1,184.10 | $3,687.11 |