- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $3,422.00 / $4,500.00 / $8,622.00
| Facility | | $3,422.00 | $4,500.00 | $8,622.00 |
- 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
- $637.54 / $1,158.81 / $1,615.49
| Facility | | $637.54 | $1,158.81 | $1,615.49 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $8,713.54 / $17,361.59 / $22,059.79
| Facility | | $8,713.54 | $17,361.59 | $22,059.79 |
- Facility/Professional
- Facility
- Modifier
- 50
- Low / Median / High Price
- $12,208.05 / $26,042.39 / $33,802.19
| Facility | 50 | $12,208.05 | $26,042.39 | $33,802.19 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2,100.00 / $10,120.00 / $45,126.00
| Facility | | $2,100.00 | $10,120.00 | $45,126.00 |