- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $455.42 / $4,261.00 / $10,043.00
| Facility | | $455.42 | $4,261.00 | $10,043.00 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2,088.00 / $4,247.00 / $9,663.00
| Facility | | $2,088.00 | $4,247.00 | $9,663.00 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $344.51 / $682.45 / $13,209.65
| Facility | | $344.51 | $682.45 | $13,209.65 |
- Facility/Professional
- Facility
- Modifier
- 50
- Low / Median / High Price
- $4,717.50 / $4,717.50 / $4,717.50
| Facility | 50 | $4,717.50 | $4,717.50 | $4,717.50 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,644.00 / $2,874.00 / $5,813.00
| Facility | | $1,644.00 | $2,874.00 | $5,813.00 |