- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,819.70 / $7,079.46 / $11,748.98
| Facility | | $1,819.70 | $7,079.46 | $11,748.98 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $3,388.44 / $12,302.69 / $30,199.52
| Facility | | $3,388.44 | $12,302.69 | $30,199.52 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,905.46 / $1,949.84 / $2,290.87
| Facility | | $1,905.46 | $1,949.84 | $2,290.87 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,584.89 / $2,137.96 / $21,379.62
| Facility | | $1,584.89 | $2,137.96 | $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 |