- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,121.14 / $7,838.38 / $8,644.27
| Facility | | $1,121.14 | $7,838.38 | $8,644.27 |
- Facility/Professional
- Facility
- Modifier
- 50
- Low / Median / High Price
- $11,874.00 / $11,874.00 / $11,874.00
| Facility | 50 | $11,874.00 | $11,874.00 | $11,874.00 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $5,887.35 / $19,655.50 / $31,514.59
| Facility | | $5,887.35 | $19,655.50 | $31,514.59 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,343.61 / $1,710.06 / $2,186.36
| Facility | | $1,343.61 | $1,710.06 | $2,186.36 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $9,028.00 / $15,131.00 / $16,269.00
| Facility | | $9,028.00 | $15,131.00 | $16,269.00 |