- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $618.75 / $4,696.00 / $11,576.00
| Facility | | $618.75 | $4,696.00 | $11,576.00 |
- Facility/Professional
- Facility
- Modifier
- 50
- Low / Median / High Price
- $947.52 / $4,166.46 / $4,166.46
| Facility | 50 | $947.52 | $4,166.46 | $4,166.46 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $494.00 / $2,417.98 / $2,878.56
| Facility | | $494.00 | $2,417.98 | $2,878.56 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $5,979.00 / $12,759.00 / $23,031.00
| Facility | | $5,979.00 | $12,759.00 | $23,031.00 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2,641.00 / $7,973.00 / $12,040.00
| Facility | | $2,641.00 | $7,973.00 | $12,040.00 |