- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,214.01 / $1,214.01 / $1,214.01
| Facility | | $1,214.01 | $1,214.01 | $1,214.01 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $916.57 / $2,110.42 / $9,204.52
| Facility | | $916.57 | $2,110.42 | $9,204.52 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2,692.72 / $3,818.61 / $9,186.18
| Facility | | $2,692.72 | $3,818.61 | $9,186.18 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2,188.98 / $3,491.12 / $7,233.21
| Facility | | $2,188.98 | $3,491.12 | $7,233.21 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,751.00 / $2,220.84 / $3,500.00
| Facility | | $1,751.00 | $2,220.84 | $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 |