- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $521.00 / $4,003.00 / $10,843.00
| Facility | | $521.00 | $4,003.00 | $10,843.00 |
- Facility/Professional
- Facility
- Modifier
- 50
- Low / Median / High Price
- $6,117.00 / $7,157.28 / $9,819.60
| Facility | 50 | $6,117.00 | $7,157.28 | $9,819.60 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $494.00 / $1,022.68 / $1,217.48
| Facility | | $494.00 | $1,022.68 | $1,217.48 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $3,105.00 / $5,731.00 / $11,037.00
| Facility | | $3,105.00 | $5,731.00 | $11,037.00 |
- 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 |