- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $741.31 / $3,019.95 / $10,000.00
| Facility | | $741.31 | $3,019.95 | $10,000.00 |
- Facility/Professional
- Facility
- Modifier
- 50
- Low / Median / High Price
- $1,513.56 / $5,370.32 / $14,125.38
| Facility | 50 | $1,513.56 | $5,370.32 | $14,125.38 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,621.81 / $4,786.30 / $13,803.84
| Facility | | $1,621.81 | $4,786.30 | $13,803.84 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $977.24 / $1,995.26 / $13,182.57
| Facility | | $977.24 | $1,995.26 | $13,182.57 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,995.26 / $5,623.41 / $12,589.25
| Facility | | $1,995.26 | $5,623.41 | $12,589.25 |