- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $461.46 / $4,933.00 / $13,415.69
| Facility | | $461.46 | $4,933.00 | $13,415.69 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2,257.39 / $2,595.37 / $3,564.68
| Facility | | $2,257.39 | $2,595.37 | $3,564.68 |
- Facility/Professional
- Facility
- Modifier
- 50
- Low / Median / High Price
- $1,416.81 / $1,782.34 / $2,416.94
| Facility | 50 | $1,416.81 | $1,782.34 | $2,416.94 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $377.47 / $4,933.00 / $13,415.69
| Facility | | $377.47 | $4,933.00 | $13,415.69 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2,248.00 / $5,202.00 / $7,355.00
| Facility | | $2,248.00 | $5,202.00 | $7,355.00 |