- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $653.75 / $2,473.00 / $6,446.00
| Facility | | $653.75 | $2,473.00 | $6,446.00 |
- Facility/Professional
- Facility
- Modifier
- 50
- Low / Median / High Price
- $918.98 / $1,156.00 / $3,420.90
| Facility | 50 | $918.98 | $1,156.00 | $3,420.90 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2,695.00 / $5,467.00 / $9,283.00
| Facility | | $2,695.00 | $5,467.00 | $9,283.00 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2,597.04 / $13,759.35 / $13,759.35
| Facility | | $2,597.04 | $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 |