- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $686.67 / $1,869.00 / $4,050.00
| Facility | | $686.67 | $1,869.00 | $4,050.00 |
- Facility/Professional
- Facility
- Modifier
- 50
- Low / Median / High Price
- $599.00 / $12,626.40 / $15,720.56
| Facility | 50 | $599.00 | $12,626.40 | $15,720.56 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $3,087.81 / $6,302.58 / $13,753.10
| Facility | | $3,087.81 | $6,302.58 | $13,753.10 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $8,447.45 / $8,447.45 / $8,447.45
| Facility | | $8,447.45 | $8,447.45 | $8,447.45 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,141.00 / $4,717.00 / $10,810.00
| Facility | | $1,141.00 | $4,717.00 | $10,810.00 |