- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $760.25 / $760.25 / $4,828.00
| Facility | | $760.25 | $760.25 | $4,828.00 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $3,024.04 / $4,764.06 / $9,450.11
| Facility | | $3,024.04 | $4,764.06 | $9,450.11 |
- 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
- $1,767.84 / $2,508.31 / $6,034.09
| Facility | | $1,767.84 | $2,508.31 | $6,034.09 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,437.87 / $2,293.19 / $4,751.25
| Facility | | $1,437.87 | $2,293.19 | $4,751.25 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $816.25 / $1,323.41 / $5,625.11
| Facility | | $816.25 | $1,323.41 | $5,625.11 |
- 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 |