- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $345.86 / $345.86 / $6,575.00
| Facility | | $345.86 | $345.86 | $6,575.00 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $4,233.39 / $7,215.03 / $14,098.13
| Facility | | $4,233.39 | $7,215.03 | $14,098.13 |
- Facility/Professional
- Facility
- Modifier
- 50
- Low / Median / High Price
- $7,949.16 / $12,060.61 / $21,147.21
| Facility | 50 | $7,949.16 | $12,060.61 | $21,147.21 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $928.17 / $1,316.27 / $3,166.46
| Facility | | $928.17 | $1,316.27 | $3,166.46 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $754.54 / $1,203.38 / $2,493.28
| Facility | | $754.54 | $1,203.38 | $2,493.28 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $480.16 / $772.17 / $7,770.00
| Facility | | $480.16 | $772.17 | $7,770.00 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2,735.00 / $4,974.00 / $8,812.00
| Facility | | $2,735.00 | $4,974.00 | $8,812.00 |