- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,193.00 / $2,121.00 / $3,917.28
| Facility | | $1,193.00 | $2,121.00 | $3,917.28 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $954.00 / $1,842.00 / $4,033.16
| Facility | | $954.00 | $1,842.00 | $4,033.16 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $950.00 / $2,064.92 / $3,740.86
| Facility | | $950.00 | $2,064.92 | $3,740.86 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,078.00 / $2,844.17 / $4,243.00
| Facility | | $1,078.00 | $2,844.17 | $4,243.00 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $743.00 / $1,940.66 / $5,311.68
| Facility | | $743.00 | $1,940.66 | $5,311.68 |