- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $538.23 / $2,683.00 / $6,681.00
| Facility | | $538.23 | $2,683.00 | $6,681.00 |
- Facility/Professional
- Facility
- Modifier
- 50
- Low / Median / High Price
- $751.50 / $3,840.77 / $4,289.55
| Facility | 50 | $751.50 | $3,840.77 | $4,289.55 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2,430.00 / $5,486.00 / $9,283.00
| Facility | | $2,430.00 | $5,486.00 | $9,283.00 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2,452.80 / $13,759.35 / $13,759.35
| Facility | | $2,452.80 | $13,759.35 | $13,759.35 |
- 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 |