- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $730.24 / $9,062.00 / $18,276.00
| Facility | | $730.24 | $9,062.00 | $18,276.00 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2,383.53 / $5,421.44 / $10,444.84
| Facility | | $2,383.53 | $5,421.44 | $10,444.84 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $715.00 / $2,048.92 / $2,632.90
| Facility | | $715.00 | $2,048.92 | $2,632.90 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $610.84 / $892.33 / $1,339.85
| Facility | | $610.84 | $892.33 | $1,339.85 |
- Facility/Professional
- Facility
- Modifier
- 50
- Low / Median / High Price
- $1,222.83 / $1,467.00 / $1,840.94
| Facility | 50 | $1,222.83 | $1,467.00 | $1,840.94 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2,764.00 / $10,147.00 / $16,816.00
| Facility | | $2,764.00 | $10,147.00 | $16,816.00 |