- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $578.00 / $4,755.00 / $11,576.00
| Facility | | $578.00 | $4,755.00 | $11,576.00 |
- Facility/Professional
- Facility
- Modifier
- 50
- Low / Median / High Price
- $35.64 / $1,865.58 / $23,755.68
| Facility | 50 | $35.64 | $1,865.58 | $23,755.68 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $494.00 / $1,389.94 / $1,654.69
| Facility | | $494.00 | $1,389.94 | $1,654.69 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $963.50 / $1,027.73 / $1,111.23
| Facility | | $963.50 | $1,027.73 | $1,111.23 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,681.00 / $5,811.00 / $10,057.00
| Facility | | $1,681.00 | $5,811.00 | $10,057.00 |