- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $713.81 / $5,797.00 / $11,576.00
| Facility | | $713.81 | $5,797.00 | $11,576.00 |
- Facility/Professional
- Facility
- Modifier
- 50
- Low / Median / High Price
- $1,667.25 / $1,667.25 / $1,667.25
| Facility | 50 | $1,667.25 | $1,667.25 | $1,667.25 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $611.00 / $1,649.96 / $1,964.23
| Facility | | $611.00 | $1,649.96 | $1,964.23 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $5,979.00 / $12,759.00 / $23,031.00
| Facility | | $5,979.00 | $12,759.00 | $23,031.00 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,936.00 / $5,811.00 / $9,651.00
| Facility | | $1,936.00 | $5,811.00 | $9,651.00 |