- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $164.25 / $2,056.00 / $4,933.00
| Facility | | $164.25 | $2,056.00 | $4,933.00 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $495.61 / $671.55 / $1,039.77
| Facility | | $495.61 | $671.55 | $1,039.77 |
- Facility/Professional
- Facility
- Modifier
- 50
- Low / Median / High Price
- $350.42 / $497.59 / $630.94
| Facility | 50 | $350.42 | $497.59 | $630.94 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $138.33 / $2,056.00 / $4,933.00
| Facility | | $138.33 | $2,056.00 | $4,933.00 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $464.00 / $1,418.00 / $2,449.00
| Facility | | $464.00 | $1,418.00 | $2,449.00 |