- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $837.02 / $2,876.00 / $7,500.00
| Facility | | $837.02 | $2,876.00 | $7,500.00 |
- Facility/Professional
- Facility
- Modifier
- 50
- Low / Median / High Price
- $3,036.00 / $5,702.46 / $5,702.46
| Facility | 50 | $3,036.00 | $5,702.46 | $5,702.46 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $7,221.62 / $11,214.31 / $17,622.49
| Facility | | $7,221.62 | $11,214.31 | $17,622.49 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $645.27 / $1,054.05 / $7,992.00
| Facility | | $645.27 | $1,054.05 | $7,992.00 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,157.00 / $4,054.00 / $7,077.94
| Facility | | $1,157.00 | $4,054.00 | $7,077.94 |