- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $407.18 / $407.18 / $6,575.00
| Facility | | $407.18 | $407.18 | $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
- $1,085.68 / $1,539.63 / $3,703.78
| Facility | | $1,085.68 | $1,539.63 | $3,703.78 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $882.58 / $1,407.59 / $2,916.36
| Facility | | $882.58 | $1,407.59 | $2,916.36 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $523.74 / $871.42 / $7,729.00
| Facility | | $523.74 | $871.42 | $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 |