- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $4,500.00 / $5,645.10 / $8,622.00
| Facility | | $4,500.00 | $5,645.10 | $8,622.00 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,895.78 / $1,895.78 / $1,901.11
| Facility | | $1,895.78 | $1,895.78 | $1,901.11 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $695.05 / $1,267.69 / $1,733.71
| Facility | | $695.05 | $1,267.69 | $1,733.71 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $5,834.98 / $7,849.65 / $9,927.16
| Facility | | $5,834.98 | $7,849.65 | $9,927.16 |
- Facility/Professional
- Facility
- Modifier
- 50
- Low / Median / High Price
- $8,236.46 / $11,774.48 / $15,293.70
| Facility | 50 | $8,236.46 | $11,774.48 | $15,293.70 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,500.00 / $9,360.00 / $17,870.00
| Facility | | $1,500.00 | $9,360.00 | $17,870.00 |