- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $421.75 / $3,697.00 / $11,050.00
| Facility | | $421.75 | $3,697.00 | $11,050.00 |
- Facility/Professional
- Facility
- Modifier
- 50
- Low / Median / High Price
- $858.50 / $872.75 / $11,271.00
| Facility | 50 | $858.50 | $872.75 | $11,271.00 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $862.00 / $2,274.00 / $7,018.00
| Facility | | $862.00 | $2,274.00 | $7,018.00 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $11,533.00 / $13,106.00 / $17,811.00
| Facility | | $11,533.00 | $13,106.00 | $17,811.00 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $179.59 / $367.66 / $11,618.76
| Facility | | $179.59 | $367.66 | $11,618.76 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,644.00 / $2,959.00 / $5,829.00
| Facility | | $1,644.00 | $2,959.00 | $5,829.00 |