- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $695.75 / $2,480.58 / $6,000.00
| Facility | | $695.75 | $2,480.58 | $6,000.00 |
- Facility/Professional
- Facility
- Modifier
- 50
- Low / Median / High Price
- $982.62 / $6,355.89 / $14,409.00
| Facility | 50 | $982.62 | $6,355.89 | $14,409.00 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $5,058.74 / $8,805.77 / $12,828.91
| Facility | | $5,058.74 | $8,805.77 | $12,828.91 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $6,856.53 / $6,856.53 / $6,856.53
| Facility | | $6,856.53 | $6,856.53 | $6,856.53 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $882.00 / $3,238.00 / $8,257.00
| Facility | | $882.00 | $3,238.00 | $8,257.00 |