- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $636.23 / $1,140.00 / $1,831.00
| Facility | | $636.23 | $1,140.00 | $1,831.00 |
- Facility/Professional
- Facility
- Modifier
- 50
- Low / Median / High Price
- $15,531.18 / $15,531.18 / $16,034.57
| Facility | 50 | $15,531.18 | $15,531.18 | $16,034.57 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2,851.25 / $2,851.25 / $2,851.25
| Facility | | $2,851.25 | $2,851.25 | $2,851.25 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2,775.00 / $2,775.00 / $7,217.33
| Facility | | $2,775.00 | $2,775.00 | $7,217.33 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $985.00 / $3,428.00 / $9,302.00
| Facility | | $985.00 | $3,428.00 | $9,302.00 |