- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $675.13 / $742.64 / $2,300.00
| Facility | | $675.13 | $742.64 | $2,300.00 |
- Facility/Professional
- Facility
- Modifier
- 50
- Low / Median / High Price
- $6,218.10 / $6,218.10 / $6,218.10
| Facility | 50 | $6,218.10 | $6,218.10 | $6,218.10 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $754.14 / $840.06 / $915.26
| Facility | | $754.14 | $840.06 | $915.26 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $806.84 / $806.84 / $806.84
| Facility | | $806.84 | $806.84 | $806.84 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $5,105.39 / $5,105.39 / $11,065.88
| Facility | | $5,105.39 | $5,105.39 | $11,065.88 |
- Facility/Professional
- Facility
- Modifier
- 50
- Low / Median / High Price
- $18,040.27 / $18,040.27 / $18,040.27
| Facility | 50 | $18,040.27 | $18,040.27 | $18,040.27 |