- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $820.16 / $2,364.00 / $8,241.00
| Facility | | $820.16 | $2,364.00 | $8,241.00 |
- Facility/Professional
- Facility
- Modifier
- 50
- Low / Median / High Price
- $1,985.75 / $3,865.94 / $9,028.64
| Facility | 50 | $1,985.75 | $3,865.94 | $9,028.64 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $5,300.93 / $5,300.93 / $6,361.12
| Facility | | $5,300.93 | $5,300.93 | $6,361.12 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $941.49 / $941.49 / $941.49
| Facility | | $941.49 | $941.49 | $941.49 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $4,726.62 / $4,726.62 / $4,726.62
| Facility | | $4,726.62 | $4,726.62 | $4,726.62 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2,104.00 / $4,334.00 / $8,676.00
| Facility | | $2,104.00 | $4,334.00 | $8,676.00 |