- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $562.34 / $7,079.46 / $12,022.64
| Facility | | $562.34 | $7,079.46 | $12,022.64 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,071.52 / $2,238.72 / $2,754.23
| Facility | | $1,071.52 | $2,238.72 | $2,754.23 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $151.36 / $1,023.29 / $1,548.82
| Facility | | $151.36 | $1,023.29 | $1,548.82 |
- 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
- $223.87 / $912.01 / $2,951.21
| Facility | | $223.87 | $912.01 | $2,951.21 |