- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $404.13 / $2,133.00 / $7,602.00
| Facility | | $404.13 | $2,133.00 | $7,602.00 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,172.00 / $2,554.00 / $3,591.00
| Facility | | $1,172.00 | $2,554.00 | $3,591.00 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $455.00 / $1,087.39 / $3,203.00
| Facility | | $455.00 | $1,087.39 | $3,203.00 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $55.00 / $4,901.45 / $4,901.45
| Facility | | $55.00 | $4,901.45 | $4,901.45 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $875.00 / $2,257.00 / $4,099.00
| Facility | | $875.00 | $2,257.00 | $4,099.00 |