- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,288.25 / $5,128.61 / $11,748.98
| Facility | | $1,288.25 | $5,128.61 | $11,748.98 |
- 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
- $954.99 / $954.99 / $1,122.02
| Facility | | $954.99 | $954.99 | $1,122.02 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,096.48 / $1,584.89 / $21,379.62
| Facility | | $1,096.48 | $1,584.89 | $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
- $4,265.80 / $9,332.54 / $14,125.38
| Facility | | $4,265.80 | $9,332.54 | $14,125.38 |