- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $362.65 / $2,104.00 / $6,980.00
| Facility | | $362.65 | $2,104.00 | $6,980.00 |
- Facility/Professional
- Facility
- Modifier
- 50
- Low / Median / High Price
- $1,664.61 / $1,664.61 / $2,888.39
| Facility | 50 | $1,664.61 | $1,664.61 | $2,888.39 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2,088.00 / $4,465.00 / $9,381.00
| Facility | | $2,088.00 | $4,465.00 | $9,381.00 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $258.90 / $258.90 / $2,105.41
| Facility | | $258.90 | $258.90 | $2,105.41 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $444.00 / $1,221.00 / $2,883.00
| Facility | | $444.00 | $1,221.00 | $2,883.00 |