- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $574.13 / $574.13 / $6,575.00
| Facility | | $574.13 | $574.13 | $6,575.00 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2,935.09 / $6,273.82 / $12,790.57
| Facility | | $2,935.09 | $6,273.82 | $12,790.57 |
- Facility/Professional
- Facility
- Modifier
- 50
- Low / Median / High Price
- $7,888.77 / $11,968.99 / $20,986.56
| Facility | 50 | $7,888.77 | $11,968.99 | $20,986.56 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,342.34 / $2,095.04 / $5,039.89
| Facility | | $1,342.34 | $2,095.04 | $5,039.89 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,163.25 / $1,911.86 / $3,968.43
| Facility | | $1,163.25 | $1,911.86 | $3,968.43 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $620.00 / $1,057.76 / $2,100.00
| Facility | | $620.00 | $1,057.76 | $2,100.00 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2,100.00 / $6,652.00 / $10,618.00
| Facility | | $2,100.00 | $6,652.00 | $10,618.00 |