- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $926.73 / $4,943.93 / $11,576.00
| Facility | | $926.73 | $4,943.93 | $11,576.00 |
- Facility/Professional
- Facility
- Modifier
- 50
- Low / Median / High Price
- $2,107.84 / $9,756.00 / $15,543.78
| Facility | 50 | $2,107.84 | $9,756.00 | $15,543.78 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $611.00 / $1,533.07 / $1,825.09
| Facility | | $611.00 | $1,533.07 | $1,825.09 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $5,979.00 / $12,759.00 / $23,031.00
| Facility | | $5,979.00 | $12,759.00 | $23,031.00 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2,637.00 / $8,136.00 / $12,748.00
| Facility | | $2,637.00 | $8,136.00 | $12,748.00 |