- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,229.47 / $1,229.47 / $1,229.47
| Facility | | $1,229.47 | $1,229.47 | $1,229.47 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $920.31 / $2,110.42 / $9,292.40
| Facility | | $920.31 | $2,110.42 | $9,292.40 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2,690.19 / $3,815.03 / $9,177.56
| Facility | | $2,690.19 | $3,815.03 | $9,177.56 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2,186.92 / $3,487.85 / $7,226.43
| Facility | | $2,186.92 | $3,487.85 | $7,226.43 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,751.00 / $2,229.46 / $3,500.00
| Facility | | $1,751.00 | $2,229.46 | $3,500.00 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,445.00 / $3,236.00 / $5,530.00
| Facility | | $1,445.00 | $3,236.00 | $5,530.00 |