- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,574.67 / $1,615.00 / $6,953.60
| Facility | | $1,574.67 | $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
- $1,535.00 / $1,889.60 / $2,897.84
| Facility | | $1,535.00 | $1,889.60 | $2,897.84 |
- 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 / $11,985.36 / $14,458.00
| Facility | | $55.00 | $11,985.36 | $14,458.00 |