- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,584.89 / $7,585.78 / $12,022.64
| Facility | | $1,584.89 | $7,585.78 | $12,022.64 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2,137.96 / $6,918.31 / $30,199.52
| Facility | | $2,137.96 | $6,918.31 | $30,199.52 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $831.76 / $870.96 / $1,000.00
| Facility | | $831.76 | $870.96 | $1,000.00 |
- 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 / $9,120.11
| Facility | | $100.00 | $100.00 | $9,120.11 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2,951.21 / $5,754.40 / $9,120.11
| Facility | | $2,951.21 | $5,754.40 | $9,120.11 |