- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $830.23 / $2,167.00 / $5,260.00
| Facility | | $830.23 | $2,167.00 | $5,260.00 |
- Facility/Professional
- Facility
- Modifier
- 50
- Low / Median / High Price
- $4,576.50 / $8,935.01 / $18,636.68
| Facility | 50 | $4,576.50 | $8,935.01 | $18,636.68 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $4,977.52 / $9,087.21 / $12,849.85
| Facility | | $4,977.52 | $9,087.21 | $12,849.85 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $5,355.81 / $5,355.81 / $5,355.81
| Facility | | $5,355.81 | $5,355.81 | $5,355.81 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,141.00 / $4,717.00 / $10,810.00
| Facility | | $1,141.00 | $4,717.00 | $10,810.00 |