- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $702.33 / $4,862.00 / $9,727.00
| Facility | | $702.33 | $4,862.00 | $9,727.00 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $3,014.37 / $7,454.68 / $13,433.48
| Facility | | $3,014.37 | $7,454.68 | $13,433.48 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $375.00 / $1,956.98 / $2,514.75
| Facility | | $375.00 | $1,956.98 | $2,514.75 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $575.00 / $751.14 / $1,386.36
| Facility | | $575.00 | $751.14 | $1,386.36 |
- Facility/Professional
- Facility
- Modifier
- 50
- Low / Median / High Price
- $862.50 / $1,126.71 / $1,764.93
| Facility | 50 | $862.50 | $1,126.71 | $1,764.93 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2,155.00 / $12,798.00 / $19,665.00
| Facility | | $2,155.00 | $12,798.00 | $19,665.00 |