- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,273.14 / $5,735.58 / $13,200.00
| Facility | | $1,273.14 | $5,735.58 | $13,200.00 |
- Facility/Professional
- Facility
- Modifier
- 50
- Low / Median / High Price
- $1,779.52 / $4,893.07 / $11,106.04
| Facility | 50 | $1,779.52 | $4,893.07 | $11,106.04 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2,930.85 / $6,156.30 / $7,242.71
| Facility | | $2,930.85 | $6,156.30 | $7,242.71 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $12,517.00 / $12,517.00 / $12,517.00
| Facility | | $12,517.00 | $12,517.00 | $12,517.00 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $853.25 / $1,538.93 / $26,542.00
| Facility | | $853.25 | $1,538.93 | $26,542.00 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,779.00 / $3,647.00 / $8,348.00
| Facility | | $1,779.00 | $3,647.00 | $8,348.00 |