- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $750.75 / $1,782.00 / $9,477.00
| Facility | | $750.75 | $1,782.00 | $9,477.00 |
- Facility/Professional
- Facility
- Modifier
- 50
- Low / Median / High Price
- $5,232.30 / $5,232.30 / $5,232.30
| Facility | 50 | $5,232.30 | $5,232.30 | $5,232.30 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $3,602.26 / $3,602.26 / $4,106.58
| Facility | | $3,602.26 | $3,602.26 | $4,106.58 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $515.00 / $1,095.00 / $3,225.91
| Facility | | $515.00 | $1,095.00 | $3,225.91 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,200.00 / $2,314.00 / $7,325.00
| Facility | | $1,200.00 | $2,314.00 | $7,325.00 |