- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $512.52 / $1,472.34 / $2,825.00
| Facility | | $512.52 | $1,472.34 | $2,825.00 |
- Facility/Professional
- Facility
- Modifier
- 50
- Low / Median / High Price
- $770.50 / $918.98 / $6,323.45
| Facility | 50 | $770.50 | $918.98 | $6,323.45 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $8,700.42 / $8,700.42 / $12,558.97
| Facility | | $8,700.42 | $8,700.42 | $12,558.97 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2,509.58 / $2,509.58 / $2,509.58
| Facility | | $2,509.58 | $2,509.58 | $2,509.58 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $860.00 / $2,913.00 / $8,411.00
| Facility | | $860.00 | $2,913.00 | $8,411.00 |