- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $513.46 / $2,311.00 / $6,681.00
| Facility | | $513.46 | $2,311.00 | $6,681.00 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,530.00 / $5,081.00 / $9,272.00
| Facility | | $1,530.00 | $5,081.00 | $9,272.00 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $455.00 / $5,059.06 / $6,644.00
| Facility | | $455.00 | $5,059.06 | $6,644.00 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $55.00 / $22,803.95 / $22,803.95
| Facility | | $55.00 | $22,803.95 | $22,803.95 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,236.00 / $4,027.00 / $7,669.00
| Facility | | $1,236.00 | $4,027.00 | $7,669.00 |