- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $644.00 / $5,839.00 / $11,576.00
| Facility | | $644.00 | $5,839.00 | $11,576.00 |
- Facility/Professional
- Facility
- Modifier
- 50
- Low / Median / High Price
- $877.83 / $8,109.07 / $8,109.07
| Facility | 50 | $877.83 | $8,109.07 | $8,109.07 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $611.00 / $1,649.96 / $1,964.23
| Facility | | $611.00 | $1,649.96 | $1,964.23 |
- 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
- $1,681.00 / $5,811.00 / $10,057.00
| Facility | | $1,681.00 | $5,811.00 | $10,057.00 |