- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $497.07 / $2,311.00 / $6,681.00
| Facility | | $497.07 | $2,311.00 | $6,681.00 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,370.00 / $3,323.00 / $5,737.00
| Facility | | $1,370.00 | $3,323.00 | $5,737.00 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $455.00 / $2,360.40 / $3,559.00
| Facility | | $455.00 | $2,360.40 | $3,559.00 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $55.00 / $10,639.60 / $10,639.60
| Facility | | $55.00 | $10,639.60 | $10,639.60 |
- 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 |