- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $513.04 / $5,917.77 / $10,882.00
| Facility | | $513.04 | $5,917.77 | $10,882.00 |
- Facility/Professional
- Facility
- Modifier
- 50
- Low / Median / High Price
- $6,675.00 / $6,675.00 / $11,655.00
| Facility | 50 | $6,675.00 | $6,675.00 | $11,655.00 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $3,438.00 / $3,438.00 / $3,438.00
| Facility | | $3,438.00 | $3,438.00 | $3,438.00 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $11,326.97 / $12,359.29 / $26,801.02
| Facility | | $11,326.97 | $12,359.29 | $26,801.02 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $5,682.00 / $9,969.00 / $19,696.00
| Facility | | $5,682.00 | $9,969.00 | $19,696.00 |