- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,080.69 / $2,359.00 / $5,506.00
| Facility | | $1,080.69 | $2,359.00 | $5,506.00 |
- Facility/Professional
- Facility
- Modifier
- 50
- Low / Median / High Price
- $519.00 / $627.00 / $8,055.00
| Facility | 50 | $519.00 | $627.00 | $8,055.00 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $438.60 / $1,704.86 / $2,700.74
| Facility | | $438.60 | $1,704.86 | $2,700.74 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $299.64 / $585.60 / $3,978.00
| Facility | | $299.64 | $585.60 | $3,978.00 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2,343.00 / $3,339.00 / $5,838.00
| Facility | | $2,343.00 | $3,339.00 | $5,838.00 |