- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $410.71 / $410.71 / $2,168.00
| Facility | | $410.71 | $410.71 | $2,168.00 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $793.01 / $4,844.72 / $10,098.06
| Facility | | $793.01 | $4,844.72 | $10,098.06 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,001.78 / $1,421.38 / $3,419.32
| Facility | | $1,001.78 | $1,421.38 | $3,419.32 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $910.71 / $1,299.48 / $2,692.38
| Facility | | $910.71 | $1,299.48 | $2,692.38 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $410.71 / $706.19 / $3,312.00
| Facility | | $410.71 | $706.19 | $3,312.00 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2,412.00 / $4,746.00 / $8,812.00
| Facility | | $2,412.00 | $4,746.00 | $8,812.00 |