- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $746.72 / $5,107.20 / $11,253.02
| Facility | | $746.72 | $5,107.20 | $11,253.02 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2,460.86 / $4,996.76 / $8,927.19
| Facility | | $2,460.86 | $4,996.76 | $8,927.19 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $375.00 / $375.00 / $1,965.14
| Facility | | $375.00 | $375.00 | $1,965.14 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $310.06 / $518.15 / $716.86
| Facility | | $310.06 | $518.15 | $716.86 |
- Facility/Professional
- Facility
- Modifier
- 50
- Low / Median / High Price
- $337.50 / $770.31 / $975.83
| Facility | 50 | $337.50 | $770.31 | $975.83 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $791.00 / $10,257.00 / $16,249.00
| Facility | | $791.00 | $10,257.00 | $16,249.00 |