- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $741.31 / $7,244.36 / $13,182.57
| Facility | | $741.31 | $7,244.36 | $13,182.57 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,905.46 / $3,715.35 / $15,135.61
| Facility | | $1,905.46 | $3,715.35 | $15,135.61 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $467.74 / $467.74 / $549.54
| Facility | | $467.74 | $467.74 | $549.54 |
- 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
- $3,388.44 / $6,165.95 / $21,379.62
| Facility | | $3,388.44 | $6,165.95 | $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 |