- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $813.30 / $3,212.00 / $9,894.00
| Facility | | $813.30 | $3,212.00 | $9,894.00 |
- Facility/Professional
- Facility
- Modifier
- 50
- Low / Median / High Price
- $2,175.00 / $6,586.37 / $13,686.00
| Facility | 50 | $2,175.00 | $6,586.37 | $13,686.00 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $4,766.52 / $9,061.76 / $13,048.12
| Facility | | $4,766.52 | $9,061.76 | $13,048.12 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $5,975.00 / $5,975.00 / $5,975.00
| Facility | | $5,975.00 | $5,975.00 | $5,975.00 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,284.00 / $5,780.00 / $12,353.00
| Facility | | $1,284.00 | $5,780.00 | $12,353.00 |