- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $105.81 / $2,056.00 / $4,933.00
| Facility | | $105.81 | $2,056.00 | $4,933.00 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $161.94 / $218.68 / $513.54
| Facility | | $161.94 | $218.68 | $513.54 |
- Facility/Professional
- Facility
- Modifier
- 50
- Low / Median / High Price
- $101.64 / $131.52 / $166.51
| Facility | 50 | $101.64 | $131.52 | $166.51 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $155.63 / $2,056.00 / $4,933.00
| Facility | | $155.63 | $2,056.00 | $4,933.00 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $645.00 / $3,005.00 / $4,504.00
| Facility | | $645.00 | $3,005.00 | $4,504.00 |