- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,089.74 / $6,007.67 / $14,333.00
| Facility | | $1,089.74 | $6,007.67 | $14,333.00 |
- Facility/Professional
- Facility
- Modifier
- 50
- Low / Median / High Price
- $2,238.50 / $6,222.77 / $25,182.67
| Facility | 50 | $2,238.50 | $6,222.77 | $25,182.67 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $323.00 / $2,673.72 / $3,183.00
| Facility | | $323.00 | $2,673.72 | $3,183.00 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $5,855.00 / $12,742.00 / $23,031.00
| Facility | | $5,855.00 | $12,742.00 | $23,031.00 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $3,320.00 / $10,309.00 / $15,888.00
| Facility | | $3,320.00 | $10,309.00 | $15,888.00 |