- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $387.35 / $3,684.00 / $12,600.00
| Facility | | $387.35 | $3,684.00 | $12,600.00 |
- Facility/Professional
- Facility
- Modifier
- 50
- Low / Median / High Price
- $6,106.50 / $6,106.50 / $6,106.50
| Facility | 50 | $6,106.50 | $6,106.50 | $6,106.50 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $7,461.91 / $11,794.01 / $18,778.93
| Facility | | $7,461.91 | $11,794.01 | $18,778.93 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $263.12 / $830.11 / $7,992.00
| Facility | | $263.12 | $830.11 | $7,992.00 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,243.00 / $5,068.00 / $8,392.00
| Facility | | $1,243.00 | $5,068.00 | $8,392.00 |