- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2,010.99 / $2,091.91 / $4,260.26
| Facility | | $2,010.99 | $2,091.91 | $4,260.26 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,807.94 / $3,698.35 / $4,783.62
| Facility | | $1,807.94 | $3,698.35 | $4,783.62 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,561.84 / $2,912.09 / $4,241.35
| Facility | | $1,561.84 | $2,912.09 | $4,241.35 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $640.00 / $2,297.69 / $4,191.39
| Facility | | $640.00 | $2,297.69 | $4,191.39 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $640.00 / $2,037.96 / $4,320.87
| Facility | | $640.00 | $2,037.96 | $4,320.87 |