- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $199.03 / $2,118.50 / $6,980.00
| Facility | | $199.03 | $2,118.50 | $6,980.00 |
- Facility/Professional
- Facility
- Modifier
- 50
- Low / Median / High Price
- $2,377.70 / $2,377.70 / $2,377.70
| Facility | 50 | $2,377.70 | $2,377.70 | $2,377.70 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,529.00 / $2,971.00 / $4,707.00
| Facility | | $1,529.00 | $2,971.00 | $4,707.00 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $371.05 / $427.07 / $603.55
| Facility | | $371.05 | $427.07 | $603.55 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $788.00 / $1,940.00 / $4,067.00
| Facility | | $788.00 | $1,940.00 | $4,067.00 |