- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $922.75 / $1,520.00 / $6,243.67
| Facility | | $922.75 | $1,520.00 | $6,243.67 |
- Facility/Professional
- Facility
- Modifier
- 50
- Low / Median / High Price
- $22.78 / $3,146.59 / $10,673.30
| Facility | 50 | $22.78 | $3,146.59 | $10,673.30 |
- Facility/Professional
- Facility
- Modifier
- 80
- Low / Median / High Price
- $4,148.00 / $4,148.00 / $4,148.00
| Facility | 80 | $4,148.00 | $4,148.00 | $4,148.00 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $4,321.85 / $5,231.95 / $7,038.65
| Facility | | $4,321.85 | $5,231.95 | $7,038.65 |
- Facility/Professional
- Facility
- Modifier
- 50
- Low / Median / High Price
- $6,482.78 / $7,847.92 / $10,557.97
| Facility | 50 | $6,482.78 | $7,847.92 | $10,557.97 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,124.00 / $3,384.00 / $5,251.00
| Facility | | $1,124.00 | $3,384.00 | $5,251.00 |