- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $816.75 / $3,848.75 / $9,883.00
| Facility | | $816.75 | $3,848.75 | $9,883.00 |
- Facility/Professional
- Facility
- Modifier
- 50
- Low / Median / High Price
- $2,875.67 / $5,699.06 / $10,398.15
| Facility | 50 | $2,875.67 | $5,699.06 | $10,398.15 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $3,302.10 / $5,944.00 / $13,012.00
| Facility | | $3,302.10 | $5,944.00 | $13,012.00 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,680.62 / $2,045.74 / $3,054.10
| Facility | | $1,680.62 | $2,045.74 | $3,054.10 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2,637.00 / $5,735.00 / $9,810.00
| Facility | | $2,637.00 | $5,735.00 | $9,810.00 |