- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $658.25 / $2,312.36 / $6,329.00
| Facility | | $658.25 | $2,312.36 | $6,329.00 |
- Facility/Professional
- Facility
- Modifier
- 50
- Low / Median / High Price
- $688.00 / $1,448.50 / $4,237.50
| Facility | 50 | $688.00 | $1,448.50 | $4,237.50 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $587.35 / $2,211.19 / $3,616.69
| Facility | | $587.35 | $2,211.19 | $3,616.69 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $4,941.68 / $4,941.68 / $4,941.68
| Facility | | $4,941.68 | $4,941.68 | $4,941.68 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $485.80 / $952.33 / $7,168.00
| Facility | | $485.80 | $952.33 | $7,168.00 |
- Facility/Professional
- Facility
- Modifier
- 50
- Low / Median / High Price
- $2,929.19 / $2,929.19 / $2,929.19
| Facility | 50 | $2,929.19 | $2,929.19 | $2,929.19 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $4,613.00 / $6,477.00 / $9,010.00
| Facility | | $4,613.00 | $6,477.00 | $9,010.00 |