- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $640.00 / $2,418.00 / $5,260.00
| Facility | | $640.00 | $2,418.00 | $5,260.00 |
- Facility/Professional
- Facility
- Modifier
- 50
- Low / Median / High Price
- $2,355.80 / $9,390.00 / $19,911.33
| Facility | 50 | $2,355.80 | $9,390.00 | $19,911.33 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $5,058.74 / $8,805.77 / $12,828.91
| Facility | | $5,058.74 | $8,805.77 | $12,828.91 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $6,828.19 / $6,828.19 / $6,828.19
| Facility | | $6,828.19 | $6,828.19 | $6,828.19 |
- 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 |