- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $977.24 / $5,754.40 / $10,964.78
| Facility | | $977.24 | $5,754.40 | $10,964.78 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,698.24 / $3,388.44 / $15,135.61
| Facility | | $1,698.24 | $3,388.44 | $15,135.61 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $512.86 / $512.86 / $602.56
| Facility | | $512.86 | $512.86 | $602.56 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $645.65 / $831.76 / $21,379.62
| Facility | | $645.65 | $831.76 | $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
- $2,454.71 / $4,466.84 / $7,413.10
| Facility | | $2,454.71 | $4,466.84 | $7,413.10 |