- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,230.53 / $1,230.53 / $1,230.53
| Facility | | $1,230.53 | $1,230.53 | $1,230.53 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $930.11 / $2,110.42 / $9,274.32
| Facility | | $930.11 | $2,110.42 | $9,274.32 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2,729.78 / $3,871.16 / $9,312.61
| Facility | | $2,729.78 | $3,871.16 | $9,312.61 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2,219.11 / $3,539.17 / $7,332.76
| Facility | | $2,219.11 | $3,539.17 | $7,332.76 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,792.99 / $2,253.11 / $3,500.00
| Facility | | $1,792.99 | $2,253.11 | $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 |