- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $958.61 / $2,678.00 / $7,602.00
| Facility | | $958.61 | $2,678.00 | $7,602.00 |
- Facility/Professional
- Facility
- Modifier
- 50
- Low / Median / High Price
- $5,086.50 / $5,086.50 / $5,086.50
| Facility | 50 | $5,086.50 | $5,086.50 | $5,086.50 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,660.00 / $2,870.00 / $4,235.00
| Facility | | $1,660.00 | $2,870.00 | $4,235.00 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2,484.78 / $5,819.45 / $26,542.00
| Facility | | $2,484.78 | $5,819.45 | $26,542.00 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,794.00 / $3,626.00 / $6,291.00
| Facility | | $1,794.00 | $3,626.00 | $6,291.00 |