- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $853.68 / $3,612.00 / $12,600.00
| Facility | | $853.68 | $3,612.00 | $12,600.00 |
- Facility/Professional
- Facility
- Modifier
- 50
- Low / Median / High Price
- $2,192.25 / $5,434.10 / $13,193.49
| Facility | 50 | $2,192.25 | $5,434.10 | $13,193.49 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $5,374.38 / $8,476.95 / $13,489.91
| Facility | | $5,374.38 | $8,476.95 | $13,489.91 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $559.15 / $1,018.14 / $9,412.67
| Facility | | $559.15 | $1,018.14 | $9,412.67 |
- Facility/Professional
- Facility
- Modifier
- 50
- Low / Median / High Price
- $6,384.00 / $6,384.00 / $6,384.00
| Facility | 50 | $6,384.00 | $6,384.00 | $6,384.00 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,481.00 / $5,524.00 / $9,232.95
| Facility | | $1,481.00 | $5,524.00 | $9,232.95 |