- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $531.28 / $2,311.00 / $7,602.00
| Facility | | $531.28 | $2,311.00 | $7,602.00 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,180.00 / $2,554.00 / $3,591.00
| Facility | | $1,180.00 | $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 / $6,482.70 / $6,482.70
| Facility | | $55.00 | $6,482.70 | $6,482.70 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,089.00 / $2,216.00 / $4,099.00
| Facility | | $1,089.00 | $2,216.00 | $4,099.00 |