- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $756.00 / $2,212.00 / $4,392.00
| Facility | | $756.00 | $2,212.00 | $4,392.00 |
- Facility/Professional
- Facility
- Modifier
- 50
- Low / Median / High Price
- $4,048.50 / $9,043.50 / $15,164.08
| Facility | 50 | $4,048.50 | $9,043.50 | $15,164.08 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $5,164.49 / $9,550.20 / $13,250.51
| Facility | | $5,164.49 | $9,550.20 | $13,250.51 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $6,337.32 / $6,337.32 / $6,337.32
| Facility | | $6,337.32 | $6,337.32 | $6,337.32 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,141.00 / $4,717.00 / $10,810.00
| Facility | | $1,141.00 | $4,717.00 | $10,810.00 |