- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $860.50 / $3,401.00 / $7,602.00
| Facility | | $860.50 | $3,401.00 | $7,602.00 |
- Facility/Professional
- Facility
- Modifier
- 50
- Low / Median / High Price
- $1,228.63 / $5,740.50 / $13,379.99
| Facility | 50 | $1,228.63 | $5,740.50 | $13,379.99 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2,201.00 / $3,927.00 / $5,959.00
| Facility | | $2,201.00 | $3,927.00 | $5,959.00 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $3,765.18 / $8,723.79 / $26,542.00
| Facility | | $3,765.18 | $8,723.79 | $26,542.00 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2,259.00 / $4,567.00 / $7,669.00
| Facility | | $2,259.00 | $4,567.00 | $7,669.00 |