- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2,566.15 / $2,566.15 / $9,768.00
| Facility | | $2,566.15 | $2,566.15 | $9,768.00 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $8,474.95 / $15,445.95 / $26,371.53
| Facility | | $8,474.95 | $15,445.95 | $26,371.53 |
- Facility/Professional
- Facility
- Modifier
- 50
- Low / Median / High Price
- $14,869.44 / $22,560.19 / $39,557.29
| Facility | 50 | $14,869.44 | $22,560.19 | $39,557.29 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $6,434.05 / $9,124.29 / $21,949.71
| Facility | | $6,434.05 | $9,124.29 | $21,949.71 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $5,230.42 / $8,341.79 / $17,283.24
| Facility | | $5,230.42 | $8,341.79 | $17,283.24 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2,566.15 / $4,611.75 / $8,689.00
| Facility | | $2,566.15 | $4,611.75 | $8,689.00 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2,080.11 / $7,872.00 / $11,531.00
| Facility | | $2,080.11 | $7,872.00 | $11,531.00 |