- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,615.00 / $2,793.45 / $6,953.60
| Facility | | $1,615.00 | $2,793.45 | $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
- $2,793.45 / $3,507.24 / $4,991.38
| Facility | | $2,793.45 | $3,507.24 | $4,991.38 |
- 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 / $23,555.61 / $28,575.81
| Facility | | $55.00 | $23,555.61 | $28,575.81 |