- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,055.51 / $4,500.00 / $19,221.62
| Facility | | $1,055.51 | $4,500.00 | $19,221.62 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $4,214.76 / $4,214.76 / $4,226.60
| Facility | | $4,214.76 | $4,214.76 | $4,226.60 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $588.05 / $1,130.47 / $1,491.82
| Facility | | $588.05 | $1,130.47 | $1,491.82 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $8,138.70 / $17,361.59 / $22,059.79
| Facility | | $8,138.70 | $17,361.59 | $22,059.79 |
- Facility/Professional
- Facility
- Modifier
- 50
- Low / Median / High Price
- $10,109.28 / $26,042.39 / $33,802.19
| Facility | 50 | $10,109.28 | $26,042.39 | $33,802.19 |
- 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 |