- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $315.18 / $3,575.00 / $5,757.00
| Facility | | $315.18 | $3,575.00 | $5,757.00 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $15,214.13 / $17,856.91 / $24,193.29
| Facility | | $15,214.13 | $17,856.91 | $24,193.29 |
- Facility/Professional
- Facility
- Modifier
- 50
- Low / Median / High Price
- $9,615.83 / $12,096.64 / $15,776.14
| Facility | 50 | $9,615.83 | $12,096.64 | $15,776.14 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $209.07 / $3,575.00 / $5,757.00
| Facility | | $209.07 | $3,575.00 | $5,757.00 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $464.00 / $1,685.00 / $20,268.00
| Facility | | $464.00 | $1,685.00 | $20,268.00 |