- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $216.96 / $2,089.00 / $6,681.00
| Facility | | $216.96 | $2,089.00 | $6,681.00 |
- Facility/Professional
- Facility
- Modifier
- 50
- Low / Median / High Price
- $750.41 / $2,834.84 / $4,195.80
| Facility | 50 | $750.41 | $2,834.84 | $4,195.80 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2,047.00 / $3,728.00 / $5,878.00
| Facility | | $2,047.00 | $3,728.00 | $5,878.00 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,000.80 / $9,133.70 / $26,542.00
| Facility | | $1,000.80 | $9,133.70 | $26,542.00 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,695.00 / $3,616.00 / $6,285.00
| Facility | | $1,695.00 | $3,616.00 | $6,285.00 |