- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,137.86 / $2,723.00 / $5,011.00
| Facility | | $1,137.86 | $2,723.00 | $5,011.00 |
- Facility/Professional
- Facility
- Modifier
- 50
- Low / Median / High Price
- $4,321.50 / $4,321.50 / $6,513.13
| Facility | 50 | $4,321.50 | $4,321.50 | $6,513.13 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,672.00 / $4,983.00 / $10,138.40
| Facility | | $1,672.00 | $4,983.00 | $10,138.40 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2,082.51 / $2,082.51 / $2,082.51
| Facility | | $2,082.51 | $2,082.51 | $2,082.51 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $803.84 / $1,745.66 / $6,679.00
| Facility | | $803.84 | $1,745.66 | $6,679.00 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2,519.27 / $2,519.27 / $4,701.33
| Facility | | $2,519.27 | $2,519.27 | $4,701.33 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2,155.00 / $5,572.00 / $26,542.00
| Facility | | $2,155.00 | $5,572.00 | $26,542.00 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2,155.00 / $4,402.00 / $8,810.00
| Facility | | $2,155.00 | $4,402.00 | $8,810.00 |