- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $685.24 / $2,678.00 / $7,602.00
| Facility | | $685.24 | $2,678.00 | $7,602.00 |
- Facility/Professional
- Facility
- Modifier
- 50
- Low / Median / High Price
- $542.50 / $2,985.00 / $14,719.63
| Facility | 50 | $542.50 | $2,985.00 | $14,719.63 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2,367.00 / $5,467.00 / $9,272.00
| Facility | | $2,367.00 | $5,467.00 | $9,272.00 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $3,151.02 / $19,913.50 / $26,542.00
| Facility | | $3,151.02 | $19,913.50 | $26,542.00 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2,905.00 / $6,073.00 / $10,104.00
| Facility | | $2,905.00 | $6,073.00 | $10,104.00 |