- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,819.70 / $5,370.32 / $14,454.40
| Facility | | $1,819.70 | $5,370.32 | $14,454.40 |
- Facility/Professional
- Facility
- Modifier
- 50
- Low / Median / High Price
- $10,232.93 / $13,803.84 / $13,803.84
| Facility | 50 | $10,232.93 | $13,803.84 | $13,803.84 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $331.13 / $436.52 / $436.52
| Facility | | $331.13 | $436.52 | $436.52 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,819.70 / $4,897.79 / $6,918.31
| Facility | | $1,819.70 | $4,897.79 | $6,918.31 |
- Facility/Professional
- Facility
- Modifier
- 50
- Low / Median / High Price
- $10,232.93 / $13,803.84 / $13,803.84
| Facility | 50 | $10,232.93 | $13,803.84 | $13,803.84 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $5,623.41 / $10,000.00 / $20,417.38
| Facility | | $5,623.41 | $10,000.00 | $20,417.38 |