- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,739.97 / $4,933.00 / $5,757.00
| Facility | | $1,739.97 | $4,933.00 | $5,757.00 |
- Facility/Professional
- Facility
- Modifier
- 50
- Low / Median / High Price
- $10,287.25 / $10,287.25 / $10,287.25
| Facility | 50 | $10,287.25 | $10,287.25 | $10,287.25 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $10,739.41 / $12,604.92 / $17,077.66
| Facility | | $10,739.41 | $12,604.92 | $17,077.66 |
- Facility/Professional
- Facility
- Modifier
- 50
- Low / Median / High Price
- $6,184.88 / $8,782.45 / $9,884.04
| Facility | 50 | $6,184.88 | $8,782.45 | $9,884.04 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,390.50 / $4,933.00 / $6,534.49
| Facility | | $1,390.50 | $4,933.00 | $6,534.49 |
- Facility/Professional
- Facility
- Modifier
- 50
- Low / Median / High Price
- $10,287.25 / $10,287.25 / $10,287.25
| Facility | 50 | $10,287.25 | $10,287.25 | $10,287.25 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $4,635.00 / $11,152.00 / $20,268.00
| Facility | | $4,635.00 | $11,152.00 | $20,268.00 |