- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $300.08 / $4,112.00 / $4,933.00
| Facility | | $300.08 | $4,112.00 | $4,933.00 |
- Facility/Professional
- Facility
- Modifier
- 50
- Low / Median / High Price
- $1,900.45 / $1,900.45 / $1,900.45
| Facility | 50 | $1,900.45 | $1,900.45 | $1,900.45 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $3,429.07 / $4,002.76 / $5,452.85
| Facility | | $3,429.07 | $4,002.76 | $5,452.85 |
- Facility/Professional
- Facility
- Modifier
- 50
- Low / Median / High Price
- $1,860.41 / $2,726.43 / $3,697.18
| Facility | 50 | $1,860.41 | $2,726.43 | $3,697.18 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $279.18 / $1,924.00 / $4,933.00
| Facility | | $279.18 | $1,924.00 | $4,933.00 |
- Facility/Professional
- Facility
- Modifier
- 50
- Low / Median / High Price
- $1,900.45 / $1,900.45 / $1,900.45
| Facility | 50 | $1,900.45 | $1,900.45 | $1,900.45 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $3,245.00 / $6,873.00 / $8,911.00
| Facility | | $3,245.00 | $6,873.00 | $8,911.00 |