- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,103.73 / $4,009.16 / $13,200.00
| Facility | | $1,103.73 | $4,009.16 | $13,200.00 |
- Facility/Professional
- Facility
- Modifier
- 50
- Low / Median / High Price
- $2,297.50 / $10,978.87 / $12,731.48
| Facility | 50 | $2,297.50 | $10,978.87 | $12,731.48 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $7,091.22 / $11,208.10 / $17,846.03
| Facility | | $7,091.22 | $11,208.10 | $17,846.03 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $717.49 / $1,173.93 / $7,992.00
| Facility | | $717.49 | $1,173.93 | $7,992.00 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,091.00 / $4,054.00 / $7,077.94
| Facility | | $1,091.00 | $4,054.00 | $7,077.94 |