- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2,359.81 / $8,399.00 / $11,581.00
| Facility | | $2,359.81 | $8,399.00 | $11,581.00 |
- Facility/Professional
- Facility
- Modifier
- 50
- Low / Median / High Price
- $4,752.30 / $4,752.30 / $4,752.30
| Facility | 50 | $4,752.30 | $4,752.30 | $4,752.30 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $5,920.00 / $15,493.10 / $29,406.00
| Facility | | $5,920.00 | $15,493.10 | $29,406.00 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2,566.59 / $3,079.91 / $4,812.35
| Facility | | $2,566.59 | $3,079.91 | $4,812.35 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $21,571.00 / $21,571.00 / $21,571.00
| Facility | | $21,571.00 | $21,571.00 | $21,571.00 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2,356.00 / $6,392.00 / $10,023.00
| Facility | | $2,356.00 | $6,392.00 | $10,023.00 |