- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $735.26 / $2,397.00 / $4,392.00
| Facility | | $735.26 | $2,397.00 | $4,392.00 |
- Facility/Professional
- Facility
- Modifier
- 50
- Low / Median / High Price
- $3,607.04 / $6,946.54 / $6,946.54
| Facility | 50 | $3,607.04 | $6,946.54 | $6,946.54 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2,879.28 / $5,833.70 / $8,973.20
| Facility | | $2,879.28 | $5,833.70 | $8,973.20 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $6,358.79 / $6,358.79 / $6,358.79
| Facility | | $6,358.79 | $6,358.79 | $6,358.79 |
- 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 |