- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $870.96 / $8,912.51 / $11,748.98
| Facility | | $870.96 | $8,912.51 | $11,748.98 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2,570.40 / $4,897.79 / $21,877.62
| Facility | | $2,570.40 | $4,897.79 | $21,877.62 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $758.58 / $776.25 / $912.01
| Facility | | $758.58 | $776.25 | $912.01 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $645.65 / $1,258.93 / $21,379.62
| Facility | | $645.65 | $1,258.93 | $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 / $100.00
| Facility | | $100.00 | $100.00 | $100.00 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,479.11 / $3,090.30 / $6,760.83
| Facility | | $1,479.11 | $3,090.30 | $6,760.83 |