- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $360.96 / $787.00 / $3,740.00
| Facility | | $360.96 | $787.00 | $3,740.00 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $4,014.00 / $8,584.00 / $11,253.00
| Facility | | $4,014.00 | $8,584.00 | $11,253.00 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $403.96 / $570.19 / $657.76
| Facility | | $403.96 | $570.19 | $657.76 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $408.80 / $511.85 / $511.85
| Facility | | $408.80 | $511.85 | $511.85 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $523.00 / $1,450.00 / $5,301.00
| Facility | | $523.00 | $1,450.00 | $5,301.00 |