- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $933.25 / $6,309.57 / $11,748.98
| Facility | | $933.25 | $6,309.57 | $11,748.98 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,698.24 / $3,715.35 / $15,135.61
| Facility | | $1,698.24 | $3,715.35 | $15,135.61 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $602.56 / $602.56 / $707.95
| Facility | | $602.56 | $602.56 | $707.95 |
- 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 / $3,981.07
| Facility | | $100.00 | $100.00 | $3,981.07 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $3,235.94 / $6,606.93 / $10,471.29
| Facility | | $3,235.94 | $6,606.93 | $10,471.29 |