- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,200.00 / $4,470.00 / $12,154.00
| Facility | | $1,200.00 | $4,470.00 | $12,154.00 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,039.67 / $1,220.08 / $1,284.30
| Facility | | $1,039.67 | $1,220.08 | $1,284.30 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $533.45 / $970.90 / $26,542.00
| Facility | | $533.45 | $970.90 | $26,542.00 |
- Facility/Professional
- Facility
- Modifier
- 50
- Low / Median / High Price
- $1,932.88 / $1,932.88 / $1,932.88
| Facility | 50 | $1,932.88 | $1,932.88 | $1,932.88 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,418.00 / $2,902.00 / $5,565.00
| Facility | | $1,418.00 | $2,902.00 | $5,565.00 |