- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $657.12 / $2,418.00 / $4,392.00
| Facility | | $657.12 | $2,418.00 | $4,392.00 |
- Facility/Professional
- Facility
- Modifier
- 50
- Low / Median / High Price
- $2,970.00 / $10,850.83 / $12,659.20
| Facility | 50 | $2,970.00 | $10,850.83 | $12,659.20 |
- 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
- $5,422.29 / $5,422.29 / $5,422.29
| Facility | | $5,422.29 | $5,422.29 | $5,422.29 |
- 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 |