- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2,300.00 / $8,621.68 / $8,621.68
| Facility | | $2,300.00 | $8,621.68 | $8,621.68 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $380.88 / $424.27 / $462.25
| Facility | | $380.88 | $424.27 | $462.25 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $409.22 / $409.22 / $409.22
| Facility | | $409.22 | $409.22 | $409.22 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $3,441.31 / $3,441.31 / $18,168.70
| Facility | | $3,441.31 | $3,441.31 | $18,168.70 |
- Facility/Professional
- Facility
- Modifier
- 50
- Low / Median / High Price
- $16,093.66 / $16,093.66 / $16,093.66
| Facility | 50 | $16,093.66 | $16,093.66 | $16,093.66 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2,450.00 / $2,450.00 / $2,450.00
| Facility | | $2,450.00 | $2,450.00 | $2,450.00 |