- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $322.77 / $1,850.00 / $3,884.00
| Facility | | $322.77 | $1,850.00 | $3,884.00 |
- Facility/Professional
- Facility
- Modifier
- 50
- Low / Median / High Price
- $827.17 / $1,191.96 / $1,806.86
| Facility | 50 | $827.17 | $1,191.96 | $1,806.86 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2,502.69 / $4,785.10 / $6,866.31
| Facility | | $2,502.69 | $4,785.10 | $6,866.31 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $122.08 / $122.08 / $122.08
| Facility | | $122.08 | $122.08 | $122.08 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $746.00 / $2,415.00 / $6,585.00
| Facility | | $746.00 | $2,415.00 | $6,585.00 |