- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $851.14 / $3,090.30 / $10,964.78
| Facility | | $851.14 | $3,090.30 | $10,964.78 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2,884.03 / $4,466.84 / $10,964.78
| Facility | | $2,884.03 | $4,466.84 | $10,964.78 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $676.08 / $977.24 / $1,148.15
| Facility | | $676.08 | $977.24 | $1,148.15 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $34.67 / $1,318.26 / $1,318.26
| Facility | | $34.67 | $1,318.26 | $1,318.26 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $977.24 / $5,011.87 / $12,302.69
| Facility | | $977.24 | $5,011.87 | $12,302.69 |