- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $912.01 / $2,818.38 / $10,471.29
| Facility | | $912.01 | $2,818.38 | $10,471.29 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $8,912.51 / $10,715.19 / $11,220.18
| Facility | | $8,912.51 | $10,715.19 | $11,220.18 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $977.24 / $1,348.96 / $1,737.80
| Facility | | $977.24 | $1,348.96 | $1,737.80 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $34.67 / $1,819.70 / $1,819.70
| Facility | | $34.67 | $1,819.70 | $1,819.70 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $851.14 / $4,677.35 / $10,000.00
| Facility | | $851.14 | $4,677.35 | $10,000.00 |