- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $546.23 / $1,850.00 / $3,945.00
| Facility | | $546.23 | $1,850.00 | $3,945.00 |
- Facility/Professional
- Facility
- Modifier
- 50
- Low / Median / High Price
- $5,899.49 / $8,166.00 / $13,686.00
| Facility | 50 | $5,899.49 | $8,166.00 | $13,686.00 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2,347.82 / $4,026.90 / $5,824.40
| Facility | | $2,347.82 | $4,026.90 | $5,824.40 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $3,686.91 / $3,686.91 / $3,686.91
| Facility | | $3,686.91 | $3,686.91 | $3,686.91 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $746.00 / $2,415.00 / $6,585.00
| Facility | | $746.00 | $2,415.00 | $6,585.00 |