- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $225.08 / $2,056.00 / $4,933.00
| Facility | | $225.08 | $2,056.00 | $4,933.00 |
- Facility/Professional
- Facility
- Modifier
- 50
- Low / Median / High Price
- $12,030.12 / $12,030.12 / $12,030.12
| Facility | 50 | $12,030.12 | $12,030.12 | $12,030.12 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $4,000.83 / $4,663.10 / $6,317.76
| Facility | | $4,000.83 | $4,663.10 | $6,317.76 |
- Facility/Professional
- Facility
- Modifier
- 50
- Low / Median / High Price
- $2,679.76 / $3,158.88 / $4,119.72
| Facility | 50 | $2,679.76 | $3,158.88 | $4,119.72 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $910.34 / $2,056.00 / $4,933.00
| Facility | | $910.34 | $2,056.00 | $4,933.00 |
- Facility/Professional
- Facility
- Modifier
- 50
- Low / Median / High Price
- $12,030.12 / $12,030.12 / $12,030.12
| Facility | 50 | $12,030.12 | $12,030.12 | $12,030.12 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $464.00 / $1,418.00 / $2,449.00
| Facility | | $464.00 | $1,418.00 | $2,449.00 |