- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,001.90 / $4,245.00 / $11,901.00
| Facility | | $1,001.90 | $4,245.00 | $11,901.00 |
- Facility/Professional
- Facility
- Modifier
- 50
- Low / Median / High Price
- $3,761.71 / $3,761.71 / $3,761.71
| Facility | 50 | $3,761.71 | $3,761.71 | $3,761.71 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $3,451.01 / $3,499.48 / $4,166.05
| Facility | | $3,451.01 | $3,499.48 | $4,166.05 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $6,078.00 / $12,767.00 / $23,031.00
| Facility | | $6,078.00 | $12,767.00 | $23,031.00 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $4,462.00 / $12,291.00 / $20,609.00
| Facility | | $4,462.00 | $12,291.00 | $20,609.00 |