- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $483.01 / $1,011.38 / $1,999.00
| Facility | | $483.01 | $1,011.38 | $1,999.00 |
- Facility/Professional
- Facility
- Modifier
- 50
- Low / Median / High Price
- $918.98 / $944.11 / $11,277.49
| Facility | 50 | $918.98 | $944.11 | $11,277.49 |
- 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 |