- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $246.85 / $6,279.12 / $13,335.00
| Facility | | $246.85 | $6,279.12 | $13,335.00 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,432.58 / $2,705.00 / $8,112.48
| Facility | | $1,432.58 | $2,705.00 | $8,112.48 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2,106.17 / $2,106.17 / $2,706.47
| Facility | | $2,106.17 | $2,106.17 | $2,706.47 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $246.85 / $1,197.21 / $1,802.82
| Facility | | $246.85 | $1,197.21 | $1,802.82 |
- Facility/Professional
- Facility
- Modifier
- 50
- Low / Median / High Price
- $538.04 / $2,086.41 / $2,651.61
| Facility | 50 | $538.04 | $2,086.41 | $2,651.61 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2,155.00 / $12,798.00 / $19,665.00
| Facility | | $2,155.00 | $12,798.00 | $19,665.00 |