- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $841.00 / $2,418.00 / $5,260.00
| Facility | | $841.00 | $2,418.00 | $5,260.00 |
- Facility/Professional
- Facility
- Modifier
- 50
- Low / Median / High Price
- $2,141.52 / $4,357.72 / $9,923.89
| Facility | 50 | $2,141.52 | $4,357.72 | $9,923.89 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $8,964.29 / $16,611.41 / $30,457.93
| Facility | | $8,964.29 | $16,611.41 | $30,457.93 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $16,579.40 / $16,579.40 / $16,579.40
| Facility | | $16,579.40 | $16,579.40 | $16,579.40 |
- 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 |