- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $245.09 / $1,397.00 / $3,912.00
| Facility | | $245.09 | $1,397.00 | $3,912.00 |
- Facility/Professional
- Facility
- Modifier
- 50
- Low / Median / High Price
- $188.20 / $750.41 / $796.50
| Facility | 50 | $188.20 | $750.41 | $796.50 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $3,390.44 / $3,390.44 / $4,068.53
| Facility | | $3,390.44 | $3,390.44 | $4,068.53 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2,953.80 / $2,953.80 / $2,953.80
| Facility | | $2,953.80 | $2,953.80 | $2,953.80 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $980.00 / $1,650.00 / $4,064.00
| Facility | | $980.00 | $1,650.00 | $4,064.00 |