- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $273.01 / $2,200.69 / $4,933.00
| Facility | | $273.01 | $2,200.69 | $4,933.00 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,548.24 / $1,804.53 / $2,444.85
| Facility | | $1,548.24 | $1,804.53 | $2,444.85 |
- Facility/Professional
- Facility
- Modifier
- 50
- Low / Median / High Price
- $971.73 / $1,222.43 / $1,378.99
| Facility | 50 | $971.73 | $1,222.43 | $1,378.99 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $273.01 / $347.07 / $6,906.00
| Facility | | $273.01 | $347.07 | $6,906.00 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $300.00 / $1,386.00 / $2,449.00
| Facility | | $300.00 | $1,386.00 | $2,449.00 |