- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $795.77 / $3,245.00 / $6,800.00
| Facility | | $795.77 | $3,245.00 | $6,800.00 |
- Facility/Professional
- Facility
- Modifier
- 50
- Low / Median / High Price
- $10,354.14 / $10,354.14 / $10,354.14
| Facility | 50 | $10,354.14 | $10,354.14 | $10,354.14 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $5,551.66 / $10,013.25 / $19,184.46
| Facility | | $5,551.66 | $10,013.25 | $19,184.46 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $12,215.04 / $12,215.04 / $12,215.04
| Facility | | $12,215.04 | $12,215.04 | $12,215.04 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,200.00 / $5,780.00 / $12,353.00
| Facility | | $1,200.00 | $5,780.00 | $12,353.00 |