- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $637.66 / $637.66 / $6,575.00
| Facility | | $637.66 | $637.66 | $6,575.00 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2,816.47 / $6,515.27 / $13,308.42
| Facility | | $2,816.47 | $6,515.27 | $13,308.42 |
- Facility/Professional
- Facility
- Modifier
- 50
- Low / Median / High Price
- $8,539.04 / $12,955.59 / $22,716.48
| Facility | 50 | $8,539.04 | $12,955.59 | $22,716.48 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,488.28 / $2,110.57 / $5,077.25
| Facility | | $1,488.28 | $2,110.57 | $5,077.25 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,209.85 / $1,929.56 / $3,997.84
| Facility | | $1,209.85 | $1,929.56 | $3,997.84 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $894.75 / $1,237.43 / $7,729.00
| Facility | | $894.75 | $1,237.43 | $7,729.00 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2,740.00 / $4,289.00 / $8,193.00
| Facility | | $2,740.00 | $4,289.00 | $8,193.00 |