- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $414.73 / $3,519.38 / $16,467.00
| Facility | | $414.73 | $3,519.38 | $16,467.00 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,400.00 / $2,705.00 / $8,385.85
| Facility | | $1,400.00 | $2,705.00 | $8,385.85 |
- 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
- $414.73 / $1,615.98 / $2,422.87
| Facility | | $414.73 | $1,615.98 | $2,422.87 |
- Facility/Professional
- Facility
- Modifier
- 50
- Low / Median / High Price
- $903.99 / $2,809.17 / $3,582.22
| Facility | 50 | $903.99 | $2,809.17 | $3,582.22 |
- 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 |