- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,348.87 / $1,615.00 / $6,953.60
| Facility | | $1,348.87 | $1,615.00 | $6,953.60 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $0.71 / $518.28 / $35,600.00
| Facility | | $0.71 | $518.28 | $35,600.00 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,246.00 / $1,618.64 / $2,495.92
| Facility | | $1,246.00 | $1,618.64 | $2,495.92 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,461.00 / $2,050.00 / $15,712.00
| Facility | | $1,461.00 | $2,050.00 | $15,712.00 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $55.00 / $10,093.76 / $13,960.05
| Facility | | $55.00 | $10,093.76 | $13,960.05 |