- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,862.00 / $1,862.00 / $3,663.00
| Facility | | $1,862.00 | $1,862.00 | $3,663.00 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,640.06 / $2,128.64 / $2,636.85
| Facility | | $1,640.06 | $2,128.64 | $2,636.85 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,860.00 / $2,146.00 / $3,929.00
| Facility | | $1,860.00 | $2,146.00 | $3,929.00 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,756.00 / $2,185.00 / $4,580.00
| Facility | | $1,756.00 | $2,185.00 | $4,580.00 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $120.00 / $2,584.00 / $6,492.00
| Facility | | $120.00 | $2,584.00 | $6,492.00 |