- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $279.89 / $4,100.00 / $8,622.00
| Facility | | $279.89 | $4,100.00 | $8,622.00 |
- Facility/Professional
- Facility
- Modifier
- 50
- Low / Median / High Price
- $2,849.15 / $3,646.94 / $5,005.00
| Facility | 50 | $2,849.15 | $3,646.94 | $5,005.00 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2,088.00 / $4,247.00 / $8,800.00
| Facility | | $2,088.00 | $4,247.00 | $8,800.00 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $678.00 / $678.00 / $848.00
| Facility | | $678.00 | $678.00 | $848.00 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $282.00 / $1,081.00 / $2,699.00
| Facility | | $282.00 | $1,081.00 | $2,699.00 |