- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,464.75 / $5,467.00 / $12,237.00
| Facility | | $1,464.75 | $5,467.00 | $12,237.00 |
- Facility/Professional
- Facility
- Modifier
- 50
- Low / Median / High Price
- $1,711.00 / $1,998.00 / $6,059.00
| Facility | 50 | $1,711.00 | $1,998.00 | $6,059.00 |
- 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
- $713.37 / $1,214.92 / $12,140.56
| Facility | | $713.37 | $1,214.92 | $12,140.56 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,779.00 / $3,647.00 / $6,988.00
| Facility | | $1,779.00 | $3,647.00 | $6,988.00 |