- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $175.31 / $4,500.00 / $5,519.00
| Facility | | $175.31 | $4,500.00 | $5,519.00 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $730.34 / $730.34 / $732.39
| Facility | | $730.34 | $730.34 | $732.39 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $65.98 / $152.44 / $280.18
| Facility | | $65.98 | $152.44 | $280.18 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,643.11 / $2,326.44 / $3,453.10
| Facility | | $1,643.11 | $2,326.44 | $3,453.10 |
- Facility/Professional
- Facility
- Modifier
- 50
- Low / Median / High Price
- $2,393.36 / $3,489.68 / $5,415.23
| Facility | 50 | $2,393.36 | $3,489.68 | $5,415.23 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $450.00 / $2,620.00 / $4,441.00
| Facility | | $450.00 | $2,620.00 | $4,441.00 |