- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $756.00 / $2,472.00 / $5,203.00
| Facility | | $756.00 | $2,472.00 | $5,203.00 |
- Facility/Professional
- Facility
- Modifier
- 50
- Low / Median / High Price
- $6,579.34 / $6,579.34 / $8,148.00
| Facility | 50 | $6,579.34 | $6,579.34 | $8,148.00 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $4,477.88 / $7,702.43 / $11,514.71
| Facility | | $4,477.88 | $7,702.43 | $11,514.71 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $8,242.45 / $8,242.45 / $8,242.45
| Facility | | $8,242.45 | $8,242.45 | $8,242.45 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $882.00 / $3,238.00 / $8,257.00
| Facility | | $882.00 | $3,238.00 | $8,257.00 |