- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $537.03 / $3,630.78 / $10,715.19
| Facility | | $537.03 | $3,630.78 | $10,715.19 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,698.24 / $3,548.13 / $15,135.61
| Facility | | $1,698.24 | $3,548.13 | $15,135.61 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $263.03 / $275.42 / $316.23
| Facility | | $263.03 | $275.42 | $316.23 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $234.42 / $363.08 / $21,379.62
| Facility | | $234.42 | $363.08 | $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 / $4,365.16
| Facility | | $100.00 | $100.00 | $4,365.16 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2,570.40 / $4,365.16 / $7,413.10
| Facility | | $2,570.40 | $4,365.16 | $7,413.10 |