- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $519.16 / $5,898.63 / $10,871.00
| Facility | | $519.16 | $5,898.63 | $10,871.00 |
- Facility/Professional
- Facility
- Modifier
- 50
- Low / Median / High Price
- $6,367.00 / $8,899.66 / $8,899.66
| Facility | 50 | $6,367.00 | $8,899.66 | $8,899.66 |
- 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
- $9,973.98 / $11,183.80 / $21,935.56
| Facility | | $9,973.98 | $11,183.80 | $21,935.56 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $4,415.00 / $7,250.00 / $10,536.00
| Facility | | $4,415.00 | $7,250.00 | $10,536.00 |