- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $661.08 / $1,494.00 / $4,276.04
| Facility | | $661.08 | $1,494.00 | $4,276.04 |
- Facility/Professional
- Facility
- Modifier
- 50
- Low / Median / High Price
- $657.75 / $5,061.00 / $5,309.30
| Facility | 50 | $657.75 | $5,061.00 | $5,309.30 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $6,727.30 / $6,727.30 / $8,072.76
| Facility | | $6,727.30 | $6,727.30 | $8,072.76 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $4,700.24 / $4,700.24 / $4,700.24
| Facility | | $4,700.24 | $4,700.24 | $4,700.24 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,565.00 / $2,828.00 / $6,957.00
| Facility | | $1,565.00 | $2,828.00 | $6,957.00 |