- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $781.00 / $1,728.00 / $2,250.00
| Facility | | $781.00 | $1,728.00 | $2,250.00 |
- Facility/Professional
- Facility
- Modifier
- 52
- Low / Median / High Price
- $1,117.60 / $1,117.60 / $1,117.60
| Facility | 52 | $1,117.60 | $1,117.60 | $1,117.60 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $3,857.69 / $4,670.04 / $6,282.70
| Facility | | $3,857.69 | $4,670.04 | $6,282.70 |
- Facility/Professional
- Facility
- Modifier
- 50
- Low / Median / High Price
- $5,786.53 / $7,005.06 / $9,424.04
| Facility | 50 | $5,786.53 | $7,005.06 | $9,424.04 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $750.00 / $2,739.00 / $4,402.00
| Facility | | $750.00 | $2,739.00 | $4,402.00 |