- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,260.33 / $1,260.33 / $1,260.33
| Facility | | $1,260.33 | $1,260.33 | $1,260.33 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $955.16 / $2,110.42 / $9,568.98
| Facility | | $955.16 | $2,110.42 | $9,568.98 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2,798.84 / $3,969.11 / $9,548.23
| Facility | | $2,798.84 | $3,969.11 | $9,548.23 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2,275.26 / $3,628.72 / $7,518.29
| Facility | | $2,275.26 | $3,628.72 | $7,518.29 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,751.00 / $2,314.13 / $3,500.00
| Facility | | $1,751.00 | $2,314.13 | $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 |