- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,043.59 / $4,400.00 / $9,841.00
| Facility | | $1,043.59 | $4,400.00 | $9,841.00 |
- Facility/Professional
- Facility
- Modifier
- 50
- Low / Median / High Price
- $2,932.23 / $6,702.18 / $13,342.42
| Facility | 50 | $2,932.23 | $6,702.18 | $13,342.42 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $4,583.00 / $9,458.00 / $18,294.00
| Facility | | $4,583.00 | $9,458.00 | $18,294.00 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2,825.44 / $3,400.69 / $4,311.98
| Facility | | $2,825.44 | $3,400.69 | $4,311.98 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $3,206.00 / $6,578.00 / $12,494.00
| Facility | | $3,206.00 | $6,578.00 | $12,494.00 |