- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $3,635.52 / $4,500.00 / $8,439.00
| Facility | | $3,635.52 | $4,500.00 | $8,439.00 |
- Facility/Professional
- Facility
- Modifier
- 50
- Low / Median / High Price
- $8,142.16 / $8,142.16 / $8,142.16
| Facility | 50 | $8,142.16 | $8,142.16 | $8,142.16 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $4,214.76 / $4,214.76 / $4,226.60
| Facility | | $4,214.76 | $4,214.76 | $4,226.60 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,249.11 / $2,311.98 / $3,666.07
| Facility | | $1,249.11 | $2,311.98 | $3,666.07 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $10,653.11 / $17,361.59 / $22,059.79
| Facility | | $10,653.11 | $17,361.59 | $22,059.79 |
- Facility/Professional
- Facility
- Modifier
- 50
- Low / Median / High Price
- $14,492.76 / $26,042.39 / $33,802.19
| Facility | 50 | $14,492.76 | $26,042.39 | $33,802.19 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2,600.00 / $11,800.00 / $29,092.00
| Facility | | $2,600.00 | $11,800.00 | $29,092.00 |