- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,700.00 / $7,655.00 / $13,151.00
| Facility | | $1,700.00 | $7,655.00 | $13,151.00 |
- Facility/Professional
- Facility
- Modifier
- 50
- Low / Median / High Price
- $5,484.00 / $5,484.00 / $5,484.00
| Facility | 50 | $5,484.00 | $5,484.00 | $5,484.00 |
- 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
- $556.41 / $1,008.26 / $26,542.00
| Facility | | $556.41 | $1,008.26 | $26,542.00 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2,269.00 / $6,170.00 / $13,488.00
| Facility | | $2,269.00 | $6,170.00 | $13,488.00 |