- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $562.00 / $2,562.00 / $7,664.00
| Facility | | $562.00 | $2,562.00 | $7,664.00 |
- Facility/Professional
- Facility
- Modifier
- 50
- Low / Median / High Price
- $5,215.60 / $5,215.60 / $5,215.60
| Facility | 50 | $5,215.60 | $5,215.60 | $5,215.60 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $4,172.80 / $7,675.74 / $10,861.26
| Facility | | $4,172.80 | $7,675.74 | $10,861.26 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $5,119.75 / $5,119.75 / $5,119.75
| Facility | | $5,119.75 | $5,119.75 | $5,119.75 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,141.00 / $4,717.00 / $10,810.00
| Facility | | $1,141.00 | $4,717.00 | $10,810.00 |