- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,217.88 / $7,671.00 / $14,307.00
| Facility | | $1,217.88 | $7,671.00 | $14,307.00 |
- Facility/Professional
- Facility
- Modifier
- 50
- Low / Median / High Price
- $3,256.12 / $5,477.08 / $13,002.28
| Facility | 50 | $3,256.12 | $5,477.08 | $13,002.28 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $3,164.13 / $12,484.00 / $54,020.00
| Facility | | $3,164.13 | $12,484.00 | $54,020.00 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $5,979.00 / $12,742.00 / $23,031.00
| Facility | | $5,979.00 | $12,742.00 | $23,031.00 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $4,072.00 / $12,949.00 / $23,109.00
| Facility | | $4,072.00 | $12,949.00 | $23,109.00 |