- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $870.96 / $5,128.61 / $12,022.64
| Facility | | $870.96 | $5,128.61 | $12,022.64 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2,754.23 / $5,754.40 / $22,908.68
| Facility | | $2,754.23 | $5,754.40 | $22,908.68 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $616.60 / $616.60 / $724.44
| Facility | | $616.60 | $616.60 | $724.44 |
- 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 / $8,912.51
| Facility | | $100.00 | $100.00 | $8,912.51 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $3,890.45 / $6,760.83 / $11,220.18
| Facility | | $3,890.45 | $6,760.83 | $11,220.18 |