- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $851.14 / $2,137.96 / $8,511.38
| Facility | | $851.14 | $2,137.96 | $8,511.38 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $8,128.31 / $10,715.19 / $13,182.57
| Facility | | $8,128.31 | $10,715.19 | $13,182.57 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,023.29 / $1,412.54 / $1,698.24
| Facility | | $1,023.29 | $1,412.54 | $1,698.24 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $34.67 / $1,905.46 / $1,905.46
| Facility | | $34.67 | $1,905.46 | $1,905.46 |
- 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 |