- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $484.08 / $484.08 / $6,575.00
| Facility | | $484.08 | $484.08 | $6,575.00 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2,868.04 / $4,764.06 / $9,166.61
| Facility | | $2,868.04 | $4,764.06 | $9,166.61 |
- Facility/Professional
- Facility
- Modifier
- 50
- Low / Median / High Price
- $5,328.39 / $8,084.34 / $14,175.17
| Facility | 50 | $5,328.39 | $8,084.34 | $14,175.17 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,128.89 / $1,601.74 / $3,853.20
| Facility | | $1,128.89 | $1,601.74 | $3,853.20 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $918.18 / $1,464.37 / $3,034.01
| Facility | | $918.18 | $1,464.37 | $3,034.01 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $586.16 / $936.64 / $5,482.84
| Facility | | $586.16 | $936.64 | $5,482.84 |
- Facility/Professional
- Facility
- Modifier
- 50
- Low / Median / High Price
- $1,797.75 / $2,795.12 / $3,782.25
| Facility | 50 | $1,797.75 | $2,795.12 | $3,782.25 |
- 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 |