- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,737.80 / $10,715.19 / $38,018.94
| Facility | | $1,737.80 | $10,715.19 | $38,018.94 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2,818.38 / $11,481.54 / $24,547.09
| Facility | | $2,818.38 | $11,481.54 | $24,547.09 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,258.93 / $1,348.96 / $1,513.56
| Facility | | $1,258.93 | $1,348.96 | $1,513.56 |
- 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 / $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 |