- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,456.00 / $4,919.00 / $12,154.00
| Facility | | $1,456.00 | $4,919.00 | $12,154.00 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,653.51 / $1,945.31 / $10,311.70
| Facility | | $1,653.51 | $1,945.31 | $10,311.70 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $402.82 / $635.69 / $9,451.00
| Facility | | $402.82 | $635.69 | $9,451.00 |
- Facility/Professional
- Facility
- Modifier
- 50
- Low / Median / High Price
- $1,795.18 / $1,795.18 / $1,795.18
| Facility | 50 | $1,795.18 | $1,795.18 | $1,795.18 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,779.00 / $3,647.00 / $6,988.00
| Facility | | $1,779.00 | $3,647.00 | $6,988.00 |