- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $101.50 / $1,291.58 / $9,727.00
| Facility | | $101.50 | $1,291.58 | $9,727.00 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,350.81 / $3,577.06 / $6,284.81
| Facility | | $1,350.81 | $3,577.06 | $6,284.81 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,221.33 / $1,221.33 / $1,569.43
| Facility | | $1,221.33 | $1,221.33 | $1,569.43 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $103.67 / $668.65 / $1,112.88
| Facility | | $103.67 | $668.65 | $1,112.88 |
- Facility/Professional
- Facility
- Modifier
- 50
- Low / Median / High Price
- $221.25 / $1,314.65 / $1,514.60
| Facility | 50 | $221.25 | $1,314.65 | $1,514.60 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,471.00 / $6,743.00 / $9,951.00
| Facility | | $1,471.00 | $6,743.00 | $9,951.00 |