- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,183.68 / $5,843.00 / $10,871.00
| Facility | | $1,183.68 | $5,843.00 | $10,871.00 |
- Facility/Professional
- Facility
- Modifier
- 50
- Low / Median / High Price
- $4,330.00 / $4,330.00 / $4,330.00
| Facility | 50 | $4,330.00 | $4,330.00 | $4,330.00 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $16,700.16 / $19,158.88 / $21,611.98
| Facility | | $16,700.16 | $19,158.88 | $21,611.98 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $17,367.83 / $17,367.83 / $33,122.22
| Facility | | $17,367.83 | $17,367.83 | $33,122.22 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $5,682.00 / $10,536.00 / $23,291.00
| Facility | | $5,682.00 | $10,536.00 | $23,291.00 |