- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $702.85 / $702.85 / $6,575.00
| Facility | | $702.85 | $702.85 | $6,575.00 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $3,242.87 / $6,726.72 / $14,294.22
| Facility | | $3,242.87 | $6,726.72 | $14,294.22 |
- Facility/Professional
- Facility
- Modifier
- 50
- Low / Median / High Price
- $8,816.17 / $13,376.05 / $23,453.73
| Facility | 50 | $8,816.17 | $13,376.05 | $23,453.73 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,635.68 / $2,320.79 / $5,582.97
| Facility | | $1,635.68 | $2,320.79 | $5,582.97 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,330.37 / $2,121.76 / $4,396.04
| Facility | | $1,330.37 | $2,121.76 | $4,396.04 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $755.22 / $1,258.70 / $6,927.00
| Facility | | $755.22 | $1,258.70 | $6,927.00 |
- Facility/Professional
- Facility
- Modifier
- 50
- Low / Median / High Price
- $3,085.34 / $3,085.34 / $3,085.34
| Facility | 50 | $3,085.34 | $3,085.34 | $3,085.34 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $3,293.00 / $6,652.00 / $9,810.00
| Facility | | $3,293.00 | $6,652.00 | $9,810.00 |