- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $346.74 / $3,715.35 / $12,022.64
| Facility | | $346.74 | $3,715.35 | $12,022.64 |
- Facility/Professional
- Facility
- Modifier
- 50
- Low / Median / High Price
- $870.96 / $870.96 / $870.96
| Facility | 50 | $870.96 | $870.96 | $870.96 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2,238.72 / $4,786.30 / $10,000.00
| Facility | | $2,238.72 | $4,786.30 | $10,000.00 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $11,481.54 / $13,182.57 / $17,782.79
| Facility | | $11,481.54 | $13,182.57 | $17,782.79 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $239.88 / $2,137.96 / $26,302.68
| Facility | | $239.88 | $2,137.96 | $26,302.68 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2,137.96 / $3,090.30 / $5,754.40
| Facility | | $2,137.96 | $3,090.30 | $5,754.40 |