- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $741.31 / $6,309.57 / $19,952.62
| Facility | | $741.31 | $6,309.57 | $19,952.62 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $3,162.28 / $8,511.38 / $60,255.96
| Facility | | $3,162.28 | $8,511.38 | $60,255.96 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $380.19 / $380.19 / $380.19
| Facility | | $380.19 | $380.19 | $380.19 |
- 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 / $38,904.51
| Facility | | $100.00 | $100.00 | $38,904.51 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $10,471.29 / $33,113.11 / $83,176.38
| Facility | | $10,471.29 | $33,113.11 | $83,176.38 |