- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $640.32 / $2,678.00 / $7,602.00
| Facility | | $640.32 | $2,678.00 | $7,602.00 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,031.00 / $2,197.00 / $4,147.00
| Facility | | $1,031.00 | $2,197.00 | $4,147.00 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $455.00 / $514.00 / $2,277.00
| Facility | | $455.00 | $514.00 | $2,277.00 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $55.00 / $1,475.98 / $1,532.40
| Facility | | $55.00 | $1,475.98 | $1,532.40 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $875.00 / $2,397.00 / $4,544.00
| Facility | | $875.00 | $2,397.00 | $4,544.00 |