- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,202.26 / $6,309.57 / $19,498.45
| Facility | | $1,202.26 | $6,309.57 | $19,498.45 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2,238.72 / $7,244.36 / $22,908.68
| Facility | | $2,238.72 | $7,244.36 | $22,908.68 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $707.95 / $707.95 / $831.76
| Facility | | $707.95 | $707.95 | $831.76 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $794.33 / $1,148.15 / $21,379.62
| Facility | | $794.33 | $1,148.15 | $21,379.62 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $3,630.78 / $11,220.18 / $21,379.62
| Facility | | $3,630.78 | $11,220.18 | $21,379.62 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $100.00 / $100.00 / $8,912.51
| Facility | | $100.00 | $100.00 | $8,912.51 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $4,265.80 / $9,332.54 / $14,125.38
| Facility | | $4,265.80 | $9,332.54 | $14,125.38 |