- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $690.00 / $3,324.00 / $7,780.00
| Facility | | $690.00 | $3,324.00 | $7,780.00 |
- Facility/Professional
- Facility
- Modifier
- 50
- Low / Median / High Price
- $5,135.70 / $5,135.70 / $5,135.70
| Facility | 50 | $5,135.70 | $5,135.70 | $5,135.70 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $3,302.10 / $5,160.00 / $10,536.00
| Facility | | $3,302.10 | $5,160.00 | $10,536.00 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2,090.96 / $2,090.96 / $2,218.40
| Facility | | $2,090.96 | $2,090.96 | $2,218.40 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2,637.00 / $5,735.00 / $9,622.00
| Facility | | $2,637.00 | $5,735.00 | $9,622.00 |