- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $826.22 / $2,678.00 / $7,602.00
| Facility | | $826.22 | $2,678.00 | $7,602.00 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,031.00 / $2,161.00 / $3,856.00
| Facility | | $1,031.00 | $2,161.00 | $3,856.00 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $475.18 / $514.00 / $2,277.00
| Facility | | $475.18 | $514.00 | $2,277.00 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $55.00 / $2,897.22 / $2,978.04
| Facility | | $55.00 | $2,897.22 | $2,978.04 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,001.00 / $3,351.00 / $6,285.00
| Facility | | $1,001.00 | $3,351.00 | $6,285.00 |