- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $227.46 / $2,130.00 / $6,681.00
| Facility | | $227.46 | $2,130.00 | $6,681.00 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,327.00 / $2,706.00 / $3,620.00
| Facility | | $1,327.00 | $2,706.00 | $3,620.00 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $455.00 / $1,087.39 / $2,813.00
| Facility | | $455.00 | $1,087.39 | $2,813.00 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $55.00 / $1,679.10 / $1,679.10
| Facility | | $55.00 | $1,679.10 | $1,679.10 |
- 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 |