- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,087.25 / $1,087.25 / $1,087.25
| Facility | | $1,087.25 | $1,087.25 | $1,087.25 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $820.97 / $2,110.42 / $8,263.65
| Facility | | $820.97 | $2,110.42 | $8,263.65 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2,402.14 / $3,406.53 / $8,194.87
| Facility | | $2,402.14 | $3,406.53 | $8,194.87 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,952.76 / $3,114.38 / $6,452.65
| Facility | | $1,952.76 | $3,114.38 | $6,452.65 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,599.54 / $1,988.92 / $3,500.00
| Facility | | $1,599.54 | $1,988.92 | $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 |