- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $4,265.80 / $7,762.47 / $13,489.63
| Facility | | $4,265.80 | $7,762.47 | $13,489.63 |
- Facility/Professional
- Facility
- Modifier
- 50
- Low / Median / High Price
- $5,623.41 / $10,471.29 / $16,218.10
| Facility | 50 | $5,623.41 | $10,471.29 | $16,218.10 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $19,498.45 / $19,498.45 / $41,686.94
| Facility | | $19,498.45 | $19,498.45 | $41,686.94 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $16,595.87 / $19,498.45 / $21,379.62
| Facility | | $16,595.87 | $19,498.45 | $21,379.62 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $7,585.78 / $19,952.62 / $36,307.81
| Facility | | $7,585.78 | $19,952.62 | $36,307.81 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $4,786.30 / $10,000.00 / $25,118.86
| Facility | | $4,786.30 | $10,000.00 | $25,118.86 |