- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $964.20 / $1,488.62 / $6,953.60
| Facility | | $964.20 | $1,488.62 | $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
- $964.20 / $1,161.73 / $1,782.11
| Facility | | $964.20 | $1,161.73 | $1,782.11 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $301.00 / $661.00 / $4,877.00
| Facility | | $301.00 | $661.00 | $4,877.00 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $55.00 / $7,280.48 / $8,807.68
| Facility | | $55.00 | $7,280.48 | $8,807.68 |