- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $548.04 / $3,706.14 / $8,500.00
| Facility | | $548.04 | $3,706.14 | $8,500.00 |
- Facility/Professional
- Facility
- Modifier
- 50
- Low / Median / High Price
- $4,331.67 / $7,610.25 / $7,610.25
| Facility | 50 | $4,331.67 | $7,610.25 | $7,610.25 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2,088.00 / $4,247.00 / $8,800.00
| Facility | | $2,088.00 | $4,247.00 | $8,800.00 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $691.65 / $691.65 / $794.00
| Facility | | $691.65 | $691.65 | $794.00 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $275.50 / $1,116.00 / $2,783.00
| Facility | | $275.50 | $1,116.00 | $2,783.00 |