- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $598.96 / $598.96 / $8,500.00
| Facility | | $598.96 | $598.96 | $8,500.00 |
- Facility/Professional
- Facility
- Modifier
- 50
- Low / Median / High Price
- $5,597.36 / $5,597.36 / $6,696.86
| Facility | 50 | $5,597.36 | $5,597.36 | $6,696.86 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $549.09 / $711.37 / $1,796.88
| Facility | | $549.09 | $711.37 | $1,796.88 |
- Facility/Professional
- Facility
- Modifier
- 50
- Low / Median / High Price
- $486.07 / $486.07 / $2,769.43
| Facility | 50 | $486.07 | $486.07 | $2,769.43 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2,545.00 / $2,545.00 / $2,545.00
| Facility | | $2,545.00 | $2,545.00 | $2,545.00 |