- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $234.42 / $2,818.38 / $10,715.19
| Facility | | $234.42 | $2,818.38 | $10,715.19 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $138.04 / $138.04 / $162.18
| Facility | | $138.04 | $138.04 | $162.18 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $21,379.62 / $21,379.62 / $21,379.62
| Facility | | $21,379.62 | $21,379.62 | $21,379.62 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $21,379.62 / $21,379.62 / $21,379.62
| Facility | | $21,379.62 | $21,379.62 | $21,379.62 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $100.00 / $100.00 / $100.00
| Facility | | $100.00 | $100.00 | $100.00 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $457.09 / $954.99 / $3,019.95
| Facility | | $457.09 | $954.99 | $3,019.95 |