- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $682.00 / $2,652.00 / $7,500.00
| Facility | | $682.00 | $2,652.00 | $7,500.00 |
- Facility/Professional
- Facility
- Modifier
- 50
- Low / Median / High Price
- $5,197.58 / $5,197.58 / $5,197.58
| Facility | 50 | $5,197.58 | $5,197.58 | $5,197.58 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $3,904.89 / $6,159.14 / $9,801.42
| Facility | | $3,904.89 | $6,159.14 | $9,801.42 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $440.96 / $735.74 / $5,543.93
| Facility | | $440.96 | $735.74 | $5,543.93 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $884.00 / $2,875.93 / $5,543.93
| Facility | | $884.00 | $2,875.93 | $5,543.93 |