- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $550.01 / $3,133.00 / $8,042.03
| Facility | | $550.01 | $3,133.00 | $8,042.03 |
- Facility/Professional
- Facility
- Modifier
- 50
- Low / Median / High Price
- $5,493.00 / $6,913.62 / $11,313.68
| Facility | 50 | $5,493.00 | $6,913.62 | $11,313.68 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2,393.00 / $4,120.00 / $8,240.00
| Facility | | $2,393.00 | $4,120.00 | $8,240.00 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2,090.96 / $2,090.96 / $2,218.40
| Facility | | $2,090.96 | $2,090.96 | $2,218.40 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2,637.00 / $5,735.00 / $9,622.00
| Facility | | $2,637.00 | $5,735.00 | $9,622.00 |