- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $579.32 / $637.25 / $3,550.00
| Facility | | $579.32 | $637.25 | $3,550.00 |
- Facility/Professional
- Facility
- Modifier
- 50
- Low / Median / High Price
- $13,785.33 / $13,785.33 / $13,785.33
| Facility | 50 | $13,785.33 | $13,785.33 | $13,785.33 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $649.42 / $721.02 / $785.57
| Facility | | $649.42 | $721.02 | $785.57 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $697.48 / $697.48 / $697.48
| Facility | | $697.48 | $697.48 | $697.48 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $6,660.54 / $6,660.54 / $6,660.54
| Facility | | $6,660.54 | $6,660.54 | $6,660.54 |