- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $750.00 / $1,831.00 / $2,825.00
| Facility | | $750.00 | $1,831.00 | $2,825.00 |
- Facility/Professional
- Facility
- Modifier
- 50
- Low / Median / High Price
- $6,475.98 / $6,475.98 / $13,428.15
| Facility | 50 | $6,475.98 | $6,475.98 | $13,428.15 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2,852.29 / $2,852.29 / $2,852.29
| Facility | | $2,852.29 | $2,852.29 | $2,852.29 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,147.00 / $2,588.88 / $6,572.11
| Facility | | $1,147.00 | $2,588.88 | $6,572.11 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,185.00 / $4,797.00 / $11,325.00
| Facility | | $1,185.00 | $4,797.00 | $11,325.00 |