- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $963.95 / $3,909.00 / $13,200.00
| Facility | | $963.95 | $3,909.00 | $13,200.00 |
- Facility/Professional
- Facility
- Modifier
- 50
- Low / Median / High Price
- $4,732.50 / $6,892.50 / $7,473.25
| Facility | 50 | $4,732.50 | $6,892.50 | $7,473.25 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $7,091.22 / $11,208.10 / $17,846.03
| Facility | | $7,091.22 | $11,208.10 | $17,846.03 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $675.39 / $1,155.93 / $7,992.00
| Facility | | $675.39 | $1,155.93 | $7,992.00 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,091.00 / $4,054.00 / $7,077.94
| Facility | | $1,091.00 | $4,054.00 | $7,077.94 |