- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,061.45 / $1,061.45 / $1,061.45
| Facility | | $1,061.45 | $1,061.45 | $1,061.45 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $806.86 / $2,130.73 / $6,163.17
| Facility | | $806.86 | $2,130.73 | $6,163.17 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2,354.13 / $3,338.45 / $8,031.08
| Facility | | $2,354.13 | $3,338.45 | $8,031.08 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,913.74 / $3,052.14 / $6,323.69
| Facility | | $1,913.74 | $3,052.14 | $6,323.69 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,635.71 / $1,954.14 / $3,500.00
| Facility | | $1,635.71 | $1,954.14 | $3,500.00 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,751.00 / $3,500.00 / $8,152.00
| Facility | | $1,751.00 | $3,500.00 | $8,152.00 |